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Machado JAD, Fantin JV, Campos JCD, Traebert E, Oliveira CD, Traebert J. Prevalence of current smoking and associated factors in older adults in Brazil. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240372. [PMID: 39292073 PMCID: PMC11404994 DOI: 10.1590/1806-9282.20240372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE The aim of this study was to estimate the prevalence of current smoking and its associated factors in adults aged 50 years and older in Brazil. METHODS This cross-sectional study utilized data from the ELSI-Brazil study, encompassing 9,412 adults aged 50 years or over. A multivariate model using Poisson regression with a robust estimator was employed, estimating prevalence ratios and their 95% confidence intervals. RESULTS The prevalence of current smoking was 17.04%. It was positively and independently associated with male gender, age up to 62 years, living without a partner, illiteracy, chronic obstructive pulmonary disease, depression, poor or very poor sleep quality, and alcohol intake more than once a month. Conversely, systemic arterial hypertension, hypercholesterolemia, diabetes mellitus, and repetitive strain injuries showed an inverse and independent association with current smoking. CONCLUSION The prevalence of current smoking among adults over 50 years old in Brazil was approximately 17%, with associations found with certain sociodemographic conditions and self-reported comorbidities.
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Affiliation(s)
| | - João Vitor Fantin
- Universidade do Sul de Santa Catarina, School of Medicine - Palhoça (SC), Brazil
| | - Juliana Coelho de Campos
- Universidade do Sul de Santa Catarina, Graduate Program in Health Sciences- Palhoça (SC), Brazil
| | - Eliane Traebert
- Universidade do Sul de Santa Catarina, School of Medicine - Palhoça (SC), Brazil
- Universidade do Sul de Santa Catarina, Graduate Program in Health Sciences- Palhoça (SC), Brazil
| | - Cesar de Oliveira
- University College London, Department of Epidemiology and Public Health - London, United Kingdom
| | - Jefferson Traebert
- Universidade do Sul de Santa Catarina, School of Medicine - Palhoça (SC), Brazil
- Universidade do Sul de Santa Catarina, Graduate Program in Health Sciences- Palhoça (SC), Brazil
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Feltrin TD, Gracioli MDSP, Cielo CA, Souza JA, Moraes DADO, Pasqualoto AS. Maximum Phonation Times as Biomarkers of Lung Function. J Voice 2024:S0892-1997(23)00406-X. [PMID: 38331702 DOI: 10.1016/j.jvoice.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE To verify whether measurements of maximal phonation times are biomarkers of forced vital capacity in patients with chronic obstructive pulmonary disease, and to characterize the vocal aspects of these patients, taking into account variables, such as age, body mass index, use of bronchodilators, presence of symptoms, and quality of life related to voice. METHODS Complete records of 25 subjects with chronic obstructive pulmonary disease, both sexes, aged 31 to 85 years, evaluated by forced vital capacity, maximum phonation times of /a/, and numerical count and number reached at this count, Vocal Symptom Scale, Voice Quality of Life. Data were presented descriptively and statistically analyzed using Student's t test for independent samples and Mann-Whitney U test. A significance level of 5% was accepted. The receiver operating characteristic curve was plotted and the standardized value of forced vital capacity <80% was considered as an indicator of pulmonary dysfunction. RESULTS Patients exhibited reduced maximum phonation times for /a/, numeric counting, and reached digits in counting; discrepancies in Vocal Signs and Symptoms and Voice Quality of Life Scale scores. Numeric counting times of up to 12.5 seconds indicated that forced vital capacity may be impaired. CONCLUSION The patients with chronic obstructive pulmonary disease examined in this study exhibited vocal deviations as evidenced by reduced maximum phonation times of /a/, numeric counting, and the digit reached during counting, as well as deviations in vocal self-assessment. Maximum phonation time in numerical counting was considered a biomarker of pulmonary function impairment.
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Zaniku HR, Connolly E, Aron MB, Matanje BL, Ndambo MK, Complex Talama G, Munyaneza F, Ruderman T, Rylance J, Dullie LW, Lalitha R, Banda NPK, Muula AS. Prevalence and Associated Factors of Chronic Obstructive Pulmonary Disease Among Adults in Neno District, Malawi: A Cross-Sectional Analytical Study. Int J Chron Obstruct Pulmon Dis 2024; 19:389-401. [PMID: 38343494 PMCID: PMC10854231 DOI: 10.2147/copd.s444378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) continues to pose a global public health challenge. However, literature is scarce on the burden of COPD in Malawi. We assessed the prevalence and risk factors for COPD among adults in Neno, Malawi. Methodology We conducted a population-based analytical cross-sectional study in Neno District between December 2021 and November 2022. Using a multi-stage sampling technique, we included 525 adults aged≥40 years. All participants underwent spirometry according to the American Thoracic Society (ATS) guidelines and were interviewed using the IMPALA questionnaire. For this study, we utilized the definition of COPD as a post-bronchodilator FEV1/FVC <0.70. We collected data using Kobo collect, exported to Microsoft Excel, and analysed using R software. We used descriptive statistics and logistic regression analysis; a p-value of <0.05 was considered statistically significant. Results Out of 525 participants, 510 participants were included in the final analysis. Fifty-eight percent of the participants were females (n=296), and 62.2% (n=317) were between 40 and 49 years with a median (IQR) age of 46 (40-86). For patient characteristics, 15.1% (n=77) were current smokers, and 4.1% (n=21) had a history of pulmonary tuberculosis (PTB). Cough was the most commonly reported respiratory symptom (n=249, 48.8%). The prevalence of COPD was 10.0% (n=51) and higher (15.0%) among males compared to females (6.4%). Factors significantly associated with COPD were age 60 years and above (adjusted odds ratio [aOR] = 3.27, 95% CI: 1.48-7.34, p<0.004), ever smoked (aOR = 6.17, 95% CI:1.89-18.7, p<0.002), current smoker (aOR = 17.6, 95% CI: 8.47-38.4, p<0.001), and previous PTB (aOR = 4.42, 95% CI: 1.16-15.5, p<0.023). Conclusion The cross-sectional prevalence of COPD in rural Malawi is high, especially among males. Factors significantly associated were older age (60 years and above), cigarette smoking, and previous PTB. Longitudinal studies are needed to better understand disease etiology and progression in this setting.
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Affiliation(s)
- Haules Robbins Zaniku
- Department of Physiotherapy, Ministry of Health, Neno District Health Office, Neno, Lilongwe, Malawi
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Emilia Connolly
- Department of Partnerships and Policy, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45529, USA
| | - Moses Banda Aron
- Monitoring and Evaluation Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
- Snakebite Envenoming Department, Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Beatrice Lydia Matanje
- Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Myness Kasanda Ndambo
- Department of Health Systems and Policy, Training and Research Unit of Excellence (TRUE), Kamuzu University of Health Sciences, Lilongwe, Malawi
| | | | - Fabien Munyaneza
- Research Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Todd Ruderman
- Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luckson Wandani Dullie
- Global Leadership Ecosystem, Partners in Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Rejani Lalitha
- Pulmonary Division, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ndaziona Peter Kwanjo Banda
- Department of Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Adamson S Muula
- Community and Environmental Health Department, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Faria AG, Molina-Bastos CG, Gonçalves MR, Schmitz CAA. Avaliação de adequabilidade de um serviço de telespirometria. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introdução: As doenças respiratórias crônicas estão entre os principais problemas de saúde pública no mundo. Mesmo sendo sensíveis ao tratamento na Atenção Primária à Saúde, são a terceira principal causa de morte no Brasil. Os serviços de telemedicina apresentam-se como aliados importantes dos profissionais de saúde no que tange ao manejo de doenças respiratórias como a asma e a doença pulmonar obstrutiva crônica. Objetivo: Avaliar a adequabilidade de um serviço de telemedicina diagnóstica em espirometria considerando os indicadores de oferta, utilização e cobertura populacional no estado do Rio Grande do Sul. Resultados: No período estudado, o serviço ofertou 27.672 exames de telespirometria aos usuários do Sistema Único de Saúde do Rio Grande do Sul encaminhados por médicos da Atenção Primária à Saúde. A utilização esteve abaixo de 50% da oferta em todas as macrorregiões de saúde do estado. Conclusões: O estudo demonstrou que a capacidade instalada pelo serviço esteve adequada para atender à demanda populacional do Rio Grande do Sul, no entanto a baixa utilização do serviço pode estar associada ao desconhecimento sobre ele e à dificuldade em reconhecer essas doenças por parte dos profissionais de saúde da Atenção Primária à Saúde.
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Bigliardi AP, Dos Santos M, Fernandes CLF, Garcia EM, Dos Santos MET, Jones MH, Soares MCF, Baisch ALM, da Silva Júnior FMR. Lung function among residents from the largest coal region in Brazil. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:46803-46812. [PMID: 35169947 DOI: 10.1007/s11356-022-19242-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Coal mining and burning activities in coal-fired power plants are among the most polluting activities in developing countries. In Brazil, the Candiota coal deposit concentrates 40% of the national mineral coal. Although, previous studies indicate several negative health outcomes to residents of this coal region, there is no information about lung function. Thus, this study aimed to evaluate lung function by spirometry among residents from the largest coal mining region of Brazil and its related factors. It was carried out a cross-sectional study with 300 male adults residing in four cities from this region. Socioeconomic, demographic, life style, and health conditions were collected through a structured questionnaire, and lung function was assessed by spirometry. Almost 18% of the residents have disorders in pulmonary function. There was significant statistical difference in the spirometry main parameters between the cities. Candiota city (host city of coal exploration activities) have the highest prevalence of obstructive ventilatory disorder. Curiously, upper economic class had significant higher risk of altered lung function (P<0.001), as well as inappropriate sewage destination (P<0.001). Residents of Candiota city had 20% higher risk of altered lung function. Regarding air quality, the PM10, SO2, and NO2 of the region were 20.6± 3.9, 7.0± 2.2, and 6.0± 1.6, respectively. Two air quality stations exceed the limit of 20 μg/m3 to PM10 proposed by Brazilian legislation and WHO, and three stations had PM10 quite close to the limit. This study points out the need for urgent action to protect residents from this coal mining region.
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Affiliation(s)
- Ana Paula Bigliardi
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Marina Dos Santos
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Caroline Lopes Feijo Fernandes
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Edariane Menestrino Garcia
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Marcelli Evans Telles Dos Santos
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Marcus Herbert Jones
- Escola de Medicina, PUCRS, Av. Ipiranga 6681 Prédio 40-9° andar CEP, Porto Alegre, RS, 90619-900, Brazil
| | - Maria Cristina Flores Soares
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Ana Luíza Muccillo Baisch
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil
| | - Flavio Manoel Rodrigues da Silva Júnior
- Laboratório de Ensaios Farmacológicos e Toxicológicos-LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande do Sul-FURG, Av. Itália, km 8, Campus Carreiros, CEP, Rio Grande, RS, 96203-900, Brazil.
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rua Visconde de Paranaguá 102 Centro, CEP, Rio Grande, RS, 96203-900, Brazil.
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Santo AH, Fernandes FLA. Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000-2019: A Multiple-Cause-of-Death Study. COPD 2022; 19:216-225. [PMID: 35416733 DOI: 10.1080/15412555.2022.2061934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) remains a compelling cause of morbidity and mortality; however, it is underestimated and undertreated in Brazil. Using multiple causes of death data from the Information System on Mortality, we evaluated, from 2000 to 2019, national proportional mortality; trends in mortality rates stratified by age, sex, and macro-region; and causes of death and seasonal variation, considering COPD as an underlying and associated cause of death. COPD occurred in 1,132,968 deaths, corresponding to a proportional mortality of 5.0% (5.2% and 4.7% among men and women), 67.6% as the underlying, and 32.4% as an associated cause of death. The standardized mortality rate decreased by 25.8% from 2000 to 2019, and the underlying, associated, male and female, Southeast, South, and Center-West region deaths revealed decreasing standardized mortality trends. The mean age at death increased from 73.2 (±12.5) to 76.0 (±12.0) years of age. Respiratory diseases were the leading underlying causes, totaling 69.8%, with COPD itself reported for 67.6% of deaths, followed by circulatory diseases (15.8%) and neoplasms (6.24%). Respiratory failure, pneumonia, septicemia, and hypertensive diseases were the major associated causes of death. Significant seasonal variations, with the highest proportional COPD mortality during winter, occurred in the southeast, south, and center-west regions. This study discloses the need and value to accurately document epidemiologic trends related to COPD in Brazil, provided its burden on mortality in older age as a significant cause of death, aiming at effective planning of mortality prevention and control.
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Affiliation(s)
- Augusto Hasiak Santo
- Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, Brazil
| | - Frederico Leon Arrabal Fernandes
- Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Pando‐Sandoval A, Ruano‐Ravina A, Candal‐Pedreira C, Rodríguez‐García C, Represas‐Represas C, Golpe R, Fernández‐Villar A, Pérez‐Ríos M. Risk factors for chronic obstructive pulmonary disease in never‐smokers: A systematic review. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:261-275. [PMID: 35142054 PMCID: PMC9060104 DOI: 10.1111/crj.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
Introduction Relatively little is known about the risk factors for chronic obstructive pulmonary disease (COPD) in never‐smokers, and these factors have not yet been fully characterised. This study therefore sought to analyse COPD risk factors in never‐smokers by conducting a systematic review of the literature on the topic. Materials and methods We performed a search in PubMed (Medline) and Embase from 2000 onwards, to locate studies on COPD in never‐smokers. For literature search and evidence synthesis purposes, we used the PRISMA guidelines and drew up a specific quality scale to quantify the evidence of each study included. Results The bibliographic search retrieved a total of 557 papers, 20 of which fulfilled the designated inclusion criteria (two case–control studies, four cohort studies and 14 cross‐sectional studies). These studies were undertaken in Europe, the United States, Latin America, Asia and Africa. The risk factors for never‐smokers were varied and ranged from exposure to biomass, occupational exposure and passive smoking to having a history of asthma, tuberculosis or respiratory infections during childhood. The effect of residential radon was unclear. The highest risk was obtained for previous respiratory diseases of any type, with a magnitude much higher than that observed for other risk factors. Conclusions There are few studies on COPD risk factors in never‐smokers. More purpose‐designed studies in this subpopulation are thus called for, including well‐designed studies to specifically assess if indoor radon has any role on COPD onset.
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Affiliation(s)
- Ana Pando‐Sandoval
- Department of Pneumology Central University Teaching Hospital of Asturias Oviedo Spain
- Department of Preventive Medicine and Public Health University of Santiago de Compostela Santiago de Compostela Spain
| | - Alberto Ruano‐Ravina
- Department of Preventive Medicine and Public Health University of Santiago de Compostela Santiago de Compostela Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública‐ CIBERESP) Madrid Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS) Santiago de Compostela Spain
| | - Cristina Candal‐Pedreira
- Department of Preventive Medicine and Public Health University of Santiago de Compostela Santiago de Compostela Spain
| | - Carlota Rodríguez‐García
- Department of Pneumology University Clinical Teaching Hospital of Santiago de Compostela Santiago de Compostela Spain
| | - Cristina Represas‐Represas
- Department of Pneumology Alvaro Cunqueiro University Teaching Hospital, NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur ‐ IISGS) Vigo Spain
| | - Rafael Golpe
- Department of Pneumology Lucus Augusti University Teaching Hospital Lugo Spain
- Grupo C039 Biodiscovery HULA‐USC Health Research Institute of Santiago de Compostela Santiago de Compostela Spain
| | - Alberto Fernández‐Villar
- Department of Pneumology Alvaro Cunqueiro University Teaching Hospital, NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur ‐ IISGS) Vigo Spain
| | - Mónica Pérez‐Ríos
- Department of Preventive Medicine and Public Health University of Santiago de Compostela Santiago de Compostela Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública‐ CIBERESP) Madrid Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS) Santiago de Compostela Spain
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Prudente R, Ferrari R, Mesquita C, Machado L, Franco E, Godoy I, Tanni S. Nine-Year Follow-Up of Interleukin 6 in Chronic Obstructive Pulmonary Disease - Complementary Results from Previous Studies. Int J Chron Obstruct Pulmon Dis 2021; 16:3019-3026. [PMID: 34764645 PMCID: PMC8572745 DOI: 10.2147/copd.s328266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Systemic manifestations of chronic obstructive pulmonary disease (COPD) are related to increased systemic inflammatory process; however, it is not entirely clear how much they are related and how the systemic inflammation, in particular interleukin-6 (IL-6), is associated with exacerbation and mortality risk. Objective To evaluate the role of IL-6 in COPD patients over nine years. Study Design and Methods A total of 133 COPD patients were assessed at baseline between 2004 and 2006 and reassessed after three and nine years through clinical evaluation, comorbidities, hematological blood count and IL-6 analysis. Results After nine years, 19 patients lost the follow-up and were not possible to identify the date of death of four patients; 12 refused to participate and 1 could not be involved due to recurrent exacerbations. Therefore, 33 patients were included in the reassessment after nine years of follow-up and 92 patients were included in the Cox mortality analysis with IL-6 as a time-dependent covariate. Regarding the inflammatory profile, in patients who survived after nine years, there was a significant increase in IL-6 [0.4 (0.2–0.8) vs 5.7 (3.4–11) pg/mL; p < 0.001] and reduction in lymphocyte count [2.1 (1.6–2.4) vs 1.4 (1.2–2.1)10^9/L; p < 0.01] with an increase in the neutrophil/lymphocyte ratio (2.0 ± 0.7 vs 2.7 ± 1.2; p = 0.003). The Cox mortality model did not show a statistical significance influence of IL-6 assessed during the follow-up. Conclusion There was a progressive increase in IL-6 during the follow-up, however, without influence on mortality.
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Affiliation(s)
- Robson Prudente
- Clinical Hospital of Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Renata Ferrari
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Carolina Mesquita
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Luiz Machado
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Estefânia Franco
- Clinical Hospital of Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Irma Godoy
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Suzana Tanni
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Bumiller-Bini V, de Freitas Oliveira-Toré C, Carvalho TM, Kretzschmar GC, Gonçalves LB, Alencar NDM, Gasparetto MA, Beltrame MH, Winter Boldt AB. MASPs at the crossroad between the complement and the coagulation cascades - the case for COVID-19. Genet Mol Biol 2021; 44:e20200199. [PMID: 33729332 PMCID: PMC7982787 DOI: 10.1590/1678-4685-gmb-2020-0199] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/20/2021] [Indexed: 01/08/2023] Open
Abstract
Components of the complement system and atypical parameters of coagulation were reported in COVID-19 patients, as well as the exacerbation of the inflammation and coagulation activity. Mannose binding lectin (MBL)- associated serine proteases (MASPs) play an important role in viral recognition and subsequent activation of the lectin pathway of the complement system and blood coagulation, connecting both processes. Genetic variants of MASP1 and MASP2 genes are further associated with different levels and functional efficiency of their encoded proteins, modulating susceptibility and severity to diseases. Our review highlights the possible role of MASPs in SARS-COV-2 binding and activation of the lectin pathway and blood coagulation cascades, as well as their associations with comorbidities of COVID-19. MASP-1 and/or MASP-2 present an increased expression in patients with COVID-19 risk factors: diabetes, arterial hypertension and cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, and cerebrovascular disease. Based also on the positive results of COVID-19 patients with anti-MASP-2 antibody, we propose the use of MASPs as a possible biomarker of the progression of COVID-19 and the investigation of new treatment strategies taking into consideration the dual role of MASPs, including MASP inhibitors as promising therapeutic targets against COVID-19.
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Affiliation(s)
- Valéria Bumiller-Bini
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Laboratório de Genética Molecular Humana, Curitiba, PR, Brazil
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Programa de Pós-Graduação em Genética, Curitiba, PR, Brazil
| | - Camila de Freitas Oliveira-Toré
- Universidade Federal do Paraná (UFPR), Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Laboratório de Imunopatologia Molecular, Curitiba, PR, Brazil
| | - Tamyres Mingorance Carvalho
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Programa de Pós-Graduação em Genética, Curitiba, PR, Brazil
- Universidade Federal do Paraná, Departamento de Genética, Laboratório de Citogenética Humana e Oncogenética, Curitiba, PR, Brazil
| | - Gabriela Canalli Kretzschmar
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Laboratório de Genética Molecular Humana, Curitiba, PR, Brazil
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Programa de Pós-Graduação em Genética, Curitiba, PR, Brazil
| | - Letícia Boslooper Gonçalves
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Programa de Pós-Graduação em Genética, Curitiba, PR, Brazil
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Laboratório de Imunogenética e Histocompatibilidade (LIGH), Curitiba, PR, Brazil
| | - Nina de Moura Alencar
- Fundação Oswaldo Cruz (Fiocruz), Instituto Carlos Chagas, Programa de Pós-Graduação em Biociências e Biotecnologia, Laboratório de Virologia Molecular, Curitiba, PR, Brazil
| | - Miguel Angelo Gasparetto
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Laboratório de Genética Molecular Humana, Curitiba, PR, Brazil
| | - Marcia Holsbach Beltrame
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Laboratório de Genética Molecular Humana, Curitiba, PR, Brazil
| | - Angelica Beate Winter Boldt
- Universidade Federal do Paraná (UFPR), Departamento de Genética, Laboratório de Genética Molecular Humana, Curitiba, PR, Brazil
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Deshmukh K, Khanna A. The Burden of Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases: A Non-Western Perspective. Tuberc Respir Dis (Seoul) 2021; 84:167-170. [PMID: 33596375 PMCID: PMC8010418 DOI: 10.4046/trd.2020.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Arjun Khanna
- Department of Pulmonary Medicine, Yashoda Hospital, Delhi, India
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11
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Batista DR, Coelho LS, Tanni SE. November 18: World COPD Day 2020. Is it a date to celebrate? J Bras Pneumol 2021; 46:e20200575. [PMID: 33439927 PMCID: PMC7909999 DOI: 10.36416/1806-3756/e20200575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diane Rezende Batista
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Liana Sousa Coelho
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
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Rosa EP, Murakami-Malaquias-da-Silva F, Palma-Cruz M, de Carvalho Garcia G, Brito AA, Andreo L, Kamei SK, Negreiros RM, Rodrigues MFDSSD, Mesquita-Ferrari RA, Bussadori SK, Fernandes KPS, Ligeiro-de-Oliveira AP, Lino-Dos-Santos-Franco A, Horliana ACRT. The impact of periodontitis in the course of chronic obstructive pulmonary disease: Pulmonary and systemic effects. Life Sci 2020; 261:118257. [PMID: 32822712 DOI: 10.1016/j.lfs.2020.118257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/01/2020] [Accepted: 08/09/2020] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to verify the impact of periodontitis in the course of chronic obstructive pulmonary disease (COPD) in C57Bl/6J mice. MAIN METHODS The animals were randomly divided into four groups (n = 8): Basal, Periodontitis (P), COPD and COPD+P. COPD was induced by orotracheal instillation of 30 μl of cigarette extract 3 times/week for 7 weeks. Periodontitis was induced by ligation technique for 22 days. Euthanasia was performed on 51st day. The analyzes were total/differential cells and cytokines recovered from bronchoalveolar lavage (BAL), total/differential blood cell count, platelets, total marrow cell count, airway collagen deposition, alveolar enlargement analyzed by mean linear intercept (Lm), mucus and bone crest reabsorption. One-way ANOVA followed by the Student-Newman-Keuls was used. KEY FINDINGS The association COPD+P decreased macrophages (p = 0,0351), TNF-α (p = 0,0071) and INF-γ (p = 0,0004) in BAL, when compared to the COPD group maintaining emphysema levels by alveolar enlargement (p < .05) reorganization of collagen fibers (p = .001) and also mean linear intercept (lm) (p = .001) and mucus (p = .0001). The periodontitis group caused TNF-α increase (p = 0, 0001) in BAL. SIGNIFICANCE Periodontitis, per se, does not alter any of the parameters analyzed, except for increased TNF-α in BAL. However, its association with COPD caused macrophages TNF-α and INF-γ alterations, when compared to the COPD group maintaining emphysema levels by alveolar enlargement and reorganization of collagen fibers. It seems that periodontitis is influencing the course of Th1 profile cell, and cytokines and pulmonary alterations. Further studies are needed to clarify the regulatory process underlying these two diseases.
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Affiliation(s)
- Ellen Perim Rosa
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Marlon Palma-Cruz
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Geovana de Carvalho Garcia
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Auriléia Aparecida Brito
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Lucas Andreo
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sergio Koiti Kamei
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Renata Matalon Negreiros
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | | | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Ana Paula Ligeiro-de-Oliveira
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
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Naranjo L, Torres-Duque CA, Colodenco D, Lopardo G, Rodriguez P, Agra de Albuquerque-Neto A, Hernandez-Zenteno RJ, Septien L, Chandler R, Ortega-Barria E, Juliao P, Guzman-Holst A. Highlights of an Expert Advisory Board on Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD) in Latin America. Int J Chron Obstruct Pulmon Dis 2020; 15:1919-1929. [PMID: 32821094 PMCID: PMC7418149 DOI: 10.2147/copd.s261258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a preventable and usually progressive lung disease that affects millions of people worldwide and is the sixth leading cause of death in the Americas. Viral and bacterial respiratory tract infections and air pollution may cause acute exacerbations of COPD (AE-COPD) ranging from mild, moderate to severe. The greatest proportion of the overall COPD burden on the health system is due to disease exacerbations. There is limited evidence regarding the etiology and burden of AE-COPD in Latin America (LATAM). Methods To respond to this gap in evidence, an Advisory Board with regional pneumologists and infectious disease experts was convened in September 2018 in Panama City, Panama, to: 1) review the burden of AE-COPD in LATAM; 2) evaluate the etiology of AE-COPD in LATAM; and 3) assess and compare the local/regional guidelines to confirm the etiology, characterize, and manage AE-COPD. Results The results of the meeting showed that there is a high prevalence of AE-COPD in LATAM countries, limited evidence on etiology data, and discrepancies in the case definitions and symptomology (ie, severity) classifications used in LATAM. Conclusion The Advisory Board discussions further resulted in recommendations for future research on the impact on the epidemiology and burden of disease, on establishing standardized AE-COPD case definition guidelines, and on studying the etiology of both moderate and severe AE-COPD cases.
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Affiliation(s)
| | | | - Daniel Colodenco
- Director of Pneumology Specialization Course, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Rodriguez
- Pulmonary and Critical Care Medicine, CEMIC, Buenos Aires, Argentina
| | | | | | - Luis Septien
- Pulmonary and Critical Care Division, National Institute of Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Reynaldo Chandler
- Education and Investigation Coordination Unit, San Miguel Arcangel Hospital, Ministry of Health, Panama City, Panama
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Fiel JA, Sarges EDSNF, Almeida CNS, Teixeira RDC, Neves LMT. Physiological response to the Glittre-ADL test in elderly COPD patients. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The Glittre-ADL (TGlittre) test was developed to assess functional capacity in a group of activities of daily living, but little is known about the physiological responses expected during its implementation. Objective: To evaluate the physiological responses induced by TGlittre in COPD patients and compare them with those induced by the 6-minute walk test (6MWT). Method: This is a cross-sectional study involving 15 elderly patients with COPD (70±6 years and predicted FEV1 of 47±16%). The TGlittre and 6MWT were performed on two different days, evaluating heart rate, peripheral oxygen saturation and perceived exertion in the 1st, 4th and 6th minutes of the 6MWT and at the start, after each lap and the end of TGlittre. After the normality test (Shapiro-Wilk), the Wilcoxon test was applied to compare the functional tests, and Spearman’s correlation coefficient to assess the association between variables. Results: At the end of TGlittre, heart rate was faster than in the 6MWT (106.7±21.9 vs 96.4±16.2bpm, p = 0.02). The other physiological variables were similar at the end of both tests. Heart rate at the end of TGlittre correlated with the final heart rate in the 6MWT (r = 0.69; p = 0.002). Conclusion: TGlittre induced a faster heart rate than in the 6MWT, with increased metabolic demand, but with similar ventilatory responses.
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Gioda A, Tonietto GB, Leon APD. Exposure to the use of firewood for cooking in Brazil and its relation with the health problems of the population. CIENCIA & SAUDE COLETIVA 2019; 24:3079-3088. [PMID: 31389554 DOI: 10.1590/1413-81232018248.23492017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022] Open
Abstract
Indoor air pollution is exacerbated by the burning of firewood in rustic stoves and poorly ventilated environments. Exposure to the pollutants emitted by this type of fuel results in increased morbidity and mortality. In Brazil, studies and estimates regarding these conditions are scarce. In order to understand this problem, the objective of this work was to investigate the use of firewood using the data series of government agencies to estimate the number of exposed people. The results indicated that firewood is the second most used fuel for cooking, being used by a significant portion of the population, more than 30 million Brazilians. A decisive factor in the increased use of this fuel is the socioeconomic level of the population associated with the price of liquefied petroleum gas (LPG). The studies carried out in the country recorded high concentrations of particles during firewood burning, exceeding the limits suggested by the World Health Organization (WHO). Associations were also observed between the exposure to the pollutants generated by the burning and the aggravation of health problems, among them respiratory diseases and cancer. Replacing fuelwood and other solid fuels with cleaner fuels should be the government's goal to minimize health costs.
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Affiliation(s)
- Adriana Gioda
- Departamento de Química, Pontifícia Universidade Católica do Rio de Janeiro. R. Marquês de São Vicente 225, Gávea. 22451-900 Rio de Janeiro RJ Brasil.
| | - Gisele Birman Tonietto
- Departamento de Química, Pontifícia Universidade Católica do Rio de Janeiro. R. Marquês de São Vicente 225, Gávea. 22451-900 Rio de Janeiro RJ Brasil.
| | - Antonio Ponce de Leon
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Marchioro J, Gazzotti MR, Moreira GL, Manzano BM, Menezes AMB, Perez-Padilla R, Jardim JR, Nascimento OA. Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study. J Bras Pneumol 2019; 45:e20170157. [PMID: 31365731 PMCID: PMC6715159 DOI: 10.1590/1806-3713/e20170157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/18/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). METHODS This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. RESULTS Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = -1.7 ± 8.1 and ΔBMI = -0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = -0.5 ± 5.4 and ΔBMI = -0.8 ± 3.3). CONCLUSIONS Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.
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Affiliation(s)
- Josiane Marchioro
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Mariana Rodrigues Gazzotti
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Graciane Laender Moreira
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Beatriz Martins Manzano
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | | | | | - José Roberto Jardim
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Oliver Augusto Nascimento
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
- . Faculdade de Medicina São Leopoldo Mandic, Campinas (SP) Brasil
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Tigala S, Sharma AR, Sachdeva K. Health risk assessment due to biomass smoke exposure in Indian indoor environment: An empirical approach using lung deposition model. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 640-641:935-942. [PMID: 29879675 DOI: 10.1016/j.scitotenv.2018.05.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 05/22/2023]
Abstract
The paper subsumes a framework that assesses health risk due to exposure to different fuel combustion through articulation of modern microscopic techniques, empirical equations, lung diagnostic tools and a pre-existing model that has been extrapolated to futuristic aspects (within controlled conditions). The framework was tested on 132 household cooks belonging to different age groups and using different types of fuel. The inhalable fraction released during fuel combustion varied in morphological characteristics and deposition site. Micrographs obtained using Scanning Electron Microscope (SEM) analysis of (biomass smoke) soot indicates aggregate formation attributing to a higher level of health risk. Further, abnormal ventilatory function along with higher risk (RR > 1) was more evident within biomass fuel users. The condition further exacerbates while using dung cakes due to high levels of emissions (294.3 particles/liter) that deposit in the upper respiratory tract (0.0899). Further, the population attributable risk percent (79%) calculated on the basis of cooking behavior suggests a 'rural culture' health determinant as clean fuel usage is not practiced as an outcome of low literacy and poor income in the region. These preliminary findings highlight the drudgery of impuissant women who are exposed to high particulate emissions on a regular basis which results in reduced lung function. Nevertheless, further cogitation is required to eliminate the limitations in this study and explore further linkages between exposure and vulnerable group to generate meaningful policy recommendations.
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Affiliation(s)
- Snehlata Tigala
- Department of Energy and Environment, TERI School of Advanced Studies, 1-0, Institutional Area, Vasant Kunj, New Delhi 110070, India.
| | - Anu Rani Sharma
- Department of Natural Resources, TERI School of Advanced Studies, 10, Institutional Area, Vasant Kunj, New Delhi 110070, India.
| | - Kamna Sachdeva
- Department of Energy and Environment, TERI School of Advanced Studies, 1-0, Institutional Area, Vasant Kunj, New Delhi 110070, India.
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Prudente R, Franco EAT, Mesquita CB, Ferrari R, de Godoy I, Tanni SE. Predictors of mortality in patients with COPD after 9 years. Int J Chron Obstruct Pulmon Dis 2018; 13:3389-3398. [PMID: 30410324 PMCID: PMC6198887 DOI: 10.2147/copd.s174665] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years. Patients and methods One hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO2), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI). Results After 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65±9 years old, and FEV1: 52.5 [40%–73%]). Male sex, age, SpO2, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36–5.04; P=0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15–5.61; P=0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11–75.75; P=0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00–1.68; P=0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00–1.76; P=0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index ≤21 kg/m2 showed increased risk of death compared to those with body mass index (BMI)>21 kg/m2 (HR: 2.70, 95% CI: 1.38–5.25; P=0.003). Conclusion After 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI ≤21 kg/m2 showed increased risk of death.
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Affiliation(s)
- Robson Prudente
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | | | - Carolina Bonfanti Mesquita
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | - Renata Ferrari
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | - Irma de Godoy
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
| | - Suzana Erico Tanni
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil,
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Hwang J, Jang M, Kim N, Choi S, Oh YM, Seo JB. Positive association between moderate altitude and chronic lower respiratory disease mortality in United States counties. PLoS One 2018; 13:e0200557. [PMID: 29995931 PMCID: PMC6040762 DOI: 10.1371/journal.pone.0200557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
For patients with chronic lower respiratory disease, hypobaric hypoxia at a high altitude is considered a risk factor for mortality. However, the effects of residing at moderately high altitudes remain unclear. We investigated the association between moderate altitude and chronic lower respiratory disease mortality. In particular, we examined the lower 48 United States counties for age-adjusted chronic lower respiratory disease mortality rates, altitude, and socioeconomic factors, including tobacco use, per capita income, population density, sex ratio, unemployment, poverty, and education between 1979 and 1998. The socioeconomic factors were incorporated into the correlation analysis as potential covariates. Considerable positive (R = 0.235; P <0.001) and partial (R = 0.260; P <0.001) correlations were observed between altitude and chronic lower respiratory disease mortality rate. In the subgroup with high COPD prevalence subgroup, even stronger positive (R = 0.346; P <0.001) and partial (R = 0.423, P <0.001) correlations were observed. Multivariate regression analysis of all available socioeconomic factors revealed that additional knowledge on altitude improved the adjusted R2 values from 0.128 to 0.186 for all counties and from 0.301 to 0.421 for counties with high COPD prevalence. We concluded that in the lower 48 United States counties, even a moderate altitude may pose considerable risks in patients with chronic lower respiratory disease.
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Affiliation(s)
- Jeongeun Hwang
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Miso Jang
- Department of Family Medicine and Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seunghyun Choi
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Garcia IFF, Tiuganji CT, Simões MDSMP, Lunardi AC. A study of measurement properties of the Life-Space Assessment questionnaire in older adults with chronic obstructive pulmonary disease. Clin Rehabil 2018; 32:1374-1382. [PMID: 29865890 DOI: 10.1177/0269215518780488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To test the measurement properties (reliability, interpretability, and validity) of the Life-Space Assessment questionnaire for older adults with chronic obstructive pulmonary disease. DESIGN Clinimetric study. SETTING Pneumology service, ambulatory care, São Paulo, SP, Brazil. PARTICIPANTS Consecutive sample of older adults ( n = 62; 38 (61%) men, 24 (39%) women) with chronic obstructive pulmonary disease. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Life-Space Assessment questionnaire assesses five space levels visited by the older adult in four weeks prior to the assessment. We tested the following measurement properties of this questionnaire: reliability (reproducibility assessed by a type-2,1 intraclass correlation coefficient (ICC2,1); internal consistency assessed by the Cronbach's alpha; measurement error by determining the standard error of measurement (SEM)), interpretability (minimum detectable change with 90% confidence (MDC90); ceiling and floor effects by calculating the proportion of participants who achieved the minimum and maximum scores), and validity by Pearson's correlation test between the Life-Space Assessment questionnaire scores and number of daily steps assessed by accelerometry. RESULTS Reproducibility (ICC2,1) was 0.90 (95% confidence interval (CI): 0.84-0.94), and internal consistency (Cronbach's α) was 0.80 (range = 0.76-0.80 for each item deleted). SEM was 3.65 points (3%), the MDC90 was 0.20 points, and we observed no ceiling (2%) or floor (6%) effects. We observed an association between the score of the Life-Space Assessment questionnaire and daily steps ( r = 0.43; P = 0.01). CONCLUSION Life-Space Assessment questionnaire shows adequate measurement properties for the assessment of life-space mobility in older adults with chronic obstructive pulmonary disease.
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Affiliation(s)
| | - Carina Tiemi Tiuganji
- 1 Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Adriana Claudia Lunardi
- 1 Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,2 Department of Physical Therapy, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Barbosa ATF, Carneiro JA, Ramos GCF, Leite MT, Caldeira AP. Factors associated with Chronic Obstructive Pulmonary Disease among the elderly. CIENCIA & SAUDE COLETIVA 2018; 22:63-73. [PMID: 28076530 DOI: 10.1590/1413-81232017221.13042016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify factors associated with Chronic Obstructive Pulmonary Disease (COPD) among non-institutionalized elderly people. It involved a cross-sectional study conducted on the basis of a household survey, followed by spirometry. People diagnosed with COPD were compared with those with normal spirometry, through bivariate analysis, followed by multivariate regression analysis. We identified 53 elderly people were identified with COPD. After multivariate analysis, the following factors associated with COPD were identified: past or current smoking (OR: 3.74; 95% CI: 1.65-8.46), presence of chronic sputum (OR: 4.92; 95% CI: 2.03-11.95), pulse oximetry at rest ≤ 90% (OR: 8.74; 95%CI: 1.27-60.07), self-reported asthma (OR: 3.41; 95% CI: 1.01-11.57). The results reveal associated factors that highlight the need to review the selection criteria for patients at risk of COPD among the elderly.
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Affiliation(s)
- Ana Teresa Fernandes Barbosa
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Jair Almeida Carneiro
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Gizele Carmen Fagundes Ramos
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Maísa Tavares Leite
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Antônio Prates Caldeira
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
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Garcia IFF, Tiuganji CT, Simões MDSMP, Santoro IL, Lunardi AC. Systemic effects of chronic obstructive pulmonary disease in young-old adults' life-space mobility. Int J Chron Obstruct Pulmon Dis 2017; 12:2777-2785. [PMID: 29026295 PMCID: PMC5627755 DOI: 10.2147/copd.s146041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective was to assess whether dyspnea, peripheral muscle strength and the level of physical activity are correlated with life-space mobility of older adults with COPD. PATIENTS AND METHODS Sixty patients over 60 years of age (40 in the COPD group and 20 in the control group) were included. All patients were evaluated for lung function (spirometry), life-space mobility (University of Alabama at Birmingham Study of Aging Life-Space Assessment), dyspnea severity (Modified Dyspnea Index), peripheral muscle strength (handgrip dynamometer), level of physical activity and number of daily steps (accelerometry). Groups were compared using unpaired t-test. Pearson's correlation was used to test the association between variables. RESULTS Life-space mobility (60.41±16.93 vs 71.07±16.28 points), dyspnea (8 [7-9] vs 11 [10-11] points), peripheral muscle strength (75.16±14.89 vs 75.50±15.13 mmHg), number of daily steps (4,865.4±2,193.3 vs 6,146.8±2,376.4 steps), and time spent in moderate to vigorous activity (197.27±146.47 vs 280.05±168.95 minutes) were lower among COPD group compared to control group (p<0.05). The difference was associated with the lower mobility of COPD group in the neighborhood. CONCLUSION Life-space mobility is decreased in young-old adults with COPD, especially at the neighborhood level. This impairment is associated to higher dyspnea, peripheral muscle weakness and the reduced level of physical activity.
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Affiliation(s)
| | - Carina Tiemi Tiuganji
- Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo
| | | | - Ilka Lopes Santoro
- Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Adriana Claudia Lunardi
- Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo
- Department of Physical Therapy, School of Medicine, University of Sao Paulo
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Sperandio EF, Arantes RL, Matheus AC, Silva RPD, Lauria VT, Romiti M, Gagliardi ARDT, Dourado VZ. Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults. J Bras Pneumol 2016; 42:22-8. [PMID: 26982037 PMCID: PMC4805383 DOI: 10.1590/s1806-37562016000000030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 10/11/2015] [Indexed: 12/13/2022] Open
Abstract
Objective : To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL), as well as with cardiovascular disease (CVD) risk factors, in asymptomatic adults. Methods : A total of 374 participants (mean age, 41 ± 14 years) underwent spirometry, which included the determination of FVC and FEV1. A restrictive pattern on spirometry was defined as an FEV1/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer. Results : A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness), the following variables retained significance (OR; 95% CI) as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8), smoking (11.6; 1.56-87.5), physical inactivity (8.1; 1.43-46.4), larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71); and dyslipidemia (1.89; 1.12-1.98). Conclusions : A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.
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Affiliation(s)
| | | | - Agatha Caveda Matheus
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - Rodrigo Pereira da Silva
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - Vinícius Tonon Lauria
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, SP, Brasil
| | - Marcello Romiti
- AngioCorpore - Instituto de Medicina Cardiovascular, Santos, SP, Brasil
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Lopes AJ, de Melo PL. Brazilian studies on pulmonary function in COPD patients: what are the gaps? Int J Chron Obstruct Pulmon Dis 2016; 11:1553-67. [PMID: 27468230 PMCID: PMC4946858 DOI: 10.2147/copd.s54328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on sensitive methods for lung-function testing. A wide body of knowledge has been accumulated in recent years showing that these methods have been significantly refined and seems promising for detection of early disease. OBJECTIVES This review focuses on research on pulmonary function analysis in COPD performed in Brazil during this century. MATERIALS AND METHODS The literature was searched using a systematic search strategy limited to English language studies that were carried out in Brazil from the year 2000 onward, with study objectives that included a focus on lung function. RESULTS After we applied our inclusion and exclusion criteria, 94 articles addressed our stated objectives. Among the new methods reviewed are the forced-oscillation technique and the nitrogen-washout test, which may provide information on small-airway abnormalities. Studies investigating the respiratory muscles and thoracoabdominal motion are also discussed, as well as studies on automatic clinical decision-support systems and complexity measurements. We also examined important gaps in the present knowledge and suggested future directions for the cited research fields. CONCLUSION There is clear evidence that improvements in lung-function methods allowed us to obtain new pathophysiological information, contributing to improvement in our understanding of COPD. In addition, they may also assist in the diagnosis and prevention of COPD. Further investigations using prospective and longitudinal design may be of interest to elucidate the use of these new methods in the diagnosis and prevention of COPD.
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Affiliation(s)
- Agnaldo José Lopes
- Pulmonary Function Laboratory, State University of Rio de Janeiro; Pulmonary Rehabilitation Laboratory, Augusto Motta University Center
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Caram LMDO, Ferrari R, Naves CR, Coelho LS, do Vale SA, Tanni SE, Godoy I. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD. J Bras Pneumol 2016; 42:179-84. [PMID: 27383930 PMCID: PMC5569610 DOI: 10.1590/s1806-37562015000000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/03/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. METHODS The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. RESULTS Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively). The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. CONCLUSIONS Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression), appear to be more prevalent in patients with mild-to-moderate COPD. OBJETIVO Avaliar e comparar a prevalência de comorbidades e de fatores de risco de doença cardiovascular (DCV) em pacientes com DPOC de acordo com a gravidade da doença. MÉTODOS O estudo incluiu 25 pacientes com DPOC leve/moderada (homens: 68%; média de idade: 65 ± 8 anos; média de VEF1: 73 ± 15% do previsto) e 25 com DPOC grave/muito grave (homens: 56%; média de idade: 69 ± 9 anos; média de VEF1, 40 ± 18% do previsto). As comorbidades foram registradas com base nos dados dos prontuários médicos e avaliações clínicas. O índice de comorbidades de Charlson foi calculado, e a pontuação na Hospital Anxiety and Depression Scale (HADS) foi determinada. RESULTADOS Dos 50 pacientes avaliados, 38 (76%) receberam diagnóstico de pelo menos uma comorbidade, sendo que 21 (42%) receberam diagnóstico de pelo menos uma DCV. Vinte e quatro pacientes (48%) apresentavam mais de uma DCV. Dezoito pacientes (36%) eram fumantes, 10 (20%) tinham depressão, 7 (14%) apresentavam dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p < 0,001, p = 0,008 e p = 0,02, respectivamente). A prevalência de pressão arterial elevada, diabetes mellitus, alcoolismo, doença isquêmica do coração e insuficiência cardíaca crônica foi semelhante nos dois grupos. O índice de comorbidades de Charlson e a pontuação na HADS não diferiram entre os grupos. CONCLUSÕES Comorbidades são muito prevalentes na DPOC, independentemente da gravidade da doença. Certos fatores de risco de DCV, eles próprios considerados doenças (incluindo tabagismo, dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.
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Affiliation(s)
- Laura Miranda de Oliveira Caram
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Renata Ferrari
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Cristiane Roberta Naves
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Liana Sousa Coelho
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Simone Alves do Vale
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Irma Godoy
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
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Nellessen AG, Donária L, Hernandes NA, Pitta F. Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD. J Bras Pneumol 2016; 41:305-12. [PMID: 26398750 PMCID: PMC4635950 DOI: 10.1590/s1806-37132015000004515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare equations for predicting peak quadriceps femoris (QF) muscle force; to determine the agreement among the equations in identifying QF muscle weakness in COPD patients; and to assess the differences in characteristics among the groups of patients classified as having or not having QF muscle weakness by each equation. Methods: Fifty-six COPD patients underwent assessment of peak QF muscle force by dynamometry (maximal voluntary isometric contraction of knee extension). Predicted values were calculated with three equations: an age-height-weight-gender equation (Eq-AHWG); an age-weight-gender equation (Eq-AWG); and an age-fat-free mass-gender equation (Eq-AFFMG). Results: Comparison of the percentage of predicted values obtained with the three equations showed that the Eq-AHWG gave higher values than did the Eq-AWG and Eq-AFFMG, with no difference between the last two. The Eq-AHWG showed moderate agreement with the Eq-AWG and Eq-AFFMG, whereas the last two also showed moderate, albeit lower, agreement with each other. In the sample as a whole, QF muscle weakness (< 80% of predicted) was identified by the Eq-AHWG, Eq-AWG, and Eq-AFFMG in 59%, 68%, and 70% of the patients, respectively (p > 0.05). Age, fat-free mass, and body mass index are characteristics that differentiate between patients with and without QF muscle weakness. Conclusions: The three equations were statistically equivalent in classifying COPD patients as having or not having QF muscle weakness. However, the Eq-AHWG gave higher peak force values than did the Eq-AWG and the Eq-AFFMG, as well as showing greater agreement with the other equations.
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Affiliation(s)
| | - Leila Donária
- Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina, PR, BR
| | | | - Fabio Pitta
- Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina, PR, BR
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Ruas G, Urquizo WEC, Abdalla GK, Abrahão DPS, Cardoso FAG, Pinheiro PS, Jamami M. Relationship of muscle strength with activities of daily living and quality of life in individuals with chronic obstructive pulmonary disease. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.001.ao08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Few activities of daily living (ADLs) in chronic obstructive pulmonary disease (COPD) are tolerated because they are associated with ventilatory and metabolic changes. Simply lifting the upper limb muscle requires changes, resulting in thoracic abdominal asynchrony, increased dyspnea, and can interfere with quality of life (QoL). Objective: to relate the muscle strength of the shoulder girdle, trunk and hand grip with the degree of dyspnea in ADLs and secondarily correlate them with QoL in individuals with chronic obstructive pulmonary disease. Materials and Methods: Nine male subjects with chronic obstructive pulmonary disease III and IV (COPDG) and nine healthy, sedentary male individuals - control group (CG) were evaluated. All patients underwent the following evaluations: Pulmonary function, muscle strength of shoulder girdle, trunk and hand grip, and questionnaires. Results: In the intergroup analysis found that the spirometric variables of the COPDG were significantly lower compared to the CG. Intragroup analysis for measures of muscle strength, found significant difference for shoulder girdle, trunk and hand grip between both groups (COPDG) with lower mean (CG). Only the shoulder girdle had a positive correlation with ADL's and QoL. Conclusion: COPDG individuals, in addition to having pulmonary compromise, showed a significant decrease in muscle strength of the shoulder girdle, trunk and hand grip when compared to the CG. Only the shoulder girdle strength was positively correlated with the level of dyspnea in ADL's in QoL. Thus, pulmonary rehabilitation is an important tool for strengthening these muscles, possibly providing a positive impact on the degree of dyspnea during ADLs and reflecting on QoL.
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Faria AC, da Costa CH, Rufino R. Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD? Int J Gen Med 2015; 8:275-81. [PMID: 26345497 PMCID: PMC4554480 DOI: 10.2147/ijgm.s86479] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction The Sleep Apnea Clinical Score (SACS) and the Berlin Questionnaire (BQ) are used to predict the likelihood of obstructive sleep apnea (OSA). The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness, a common OSA symptom. These clinical tools help prioritize individuals with the most severe illness regarding on whom polysomnography (PSG) should be performed. It is necessary to check the applicability of these tools in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare SACS, BQ, and ESS performance in patients with COPD. Methods The SACS, BQ, and ESS were applied to 91 patients with COPD. From this group, 24 underwent PSG. In this transversal study, these three tests were compared regarding their likelihood to predict OSA in patients with COPD using receiver-operating characteristic curve statistics. Results In this sample, 58 (63.7%) patients were men, and their mean age was 69.4±9.6 years. Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS. From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria. BQ and ESS did not accurately predict OSA in this group of patients with COPD, with a receiver-operating characteristic curve area under the curves of 0.54 (95% CI: 0.329–0.745, P=0.75) and 0.69 (95% CI: 0.47–0.860, P=0.10), respectively. SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606–0.943, P=0.02). Conclusion SACS was better than BQ and ESS in predicting OSA in this group of patients with COPD.
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Affiliation(s)
- Anamelia Costa Faria
- Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Rogério Rufino
- Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Moreira GL, Gazzotti MR, Manzano BM, Nascimento O, Perez-Padilla R, Menezes AMB, Jardim JR. Incidence of chronic obstructive pulmonary disease based on three spirometric diagnostic criteria in Sao Paulo, Brazil: a nine-year follow-up since the PLATINO prevalence study. SAO PAULO MED J 2015; 133:245-51. [PMID: 26176929 PMCID: PMC10876369 DOI: 10.1590/1516-3180.2015.9620902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 09/10/2014] [Accepted: 02/09/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a respiratory disease of high prevalence and socioeconomic impact worldwide. It affects approximately 16% of the population of São Paulo. The incidence of COPD is still unknown in Brazil. The aim of this study was to estimate new cases of COPD in a population-based sample in São Paulo, Brazil, using three different spirometric diagnostic criteria, and to assess the concordance between these criteria. DESIGN AND SETTING Prospective cohort study, in the city of São Paulo, Brazil. METHODS A questionnaire was applied and anthropometry and pre and post-bronchodilator spirometry were performed on the same subjects as in the initial PLATINO study (2003) in São Paulo. Data from this follow-up study were added to the original database of the initial phase. Incident COPD cases refer to subjects who developed the disease in accordance with each spirometric criterion during the nine-year follow-up period. The Statistical Package for the Social Sciences, version 17.0 (SPSS Inc., Chicago, IL, USA) was used in the analysis and the significance level was set at P < 0.05. RESULTS 613 subjects participated in the follow-up. New COPD cases ranged in frequency from 1.4% to 4.0%, depending on the diagnostic criterion used. The concordance between the criteria ranged from 35% to 60%. CONCLUSION The incidence of COPD after a nine-year follow-up was high, but varied according to the spirometric criterion used. The agreement between the criteria for identifying new cases of the disease ranged from 35% to 60%.
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Affiliation(s)
- Graciane Laender Moreira
- PhD. Physiotherapist, Department of Translational Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | | | - Beatriz Martins Manzano
- PhD. Physiotherapist, Department of Translational Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Oliver Nascimento
- MD, PhD. Pulmonology Sector, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Rogelio Perez-Padilla
- MD. Adjunct Professor, National Institute of Respiratory Diseases, Mexico City, Mexico.
| | - Ana Maria Baptista Menezes
- MD, PhD. Adjunct Professor, Department of Internal Medicine, School of Medicine, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.
| | - José Roberto Jardim
- MD, PhD. Adjunct Professor, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
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Jaganath D, Miranda JJ, Gilman RH, Wise RA, Diette GB, Miele CH, Bernabe-Ortiz A, Checkley W. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru. Respir Res 2015; 16:40. [PMID: 25889777 PMCID: PMC4389577 DOI: 10.1186/s12931-015-0198-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/27/2015] [Indexed: 12/17/2022] Open
Abstract
Background It is unclear how geographic and social diversity affects the prevalence of chronic obstructive pulmonary disease (COPD). We sought to characterize the prevalence of COPD and identify risk factors across four settings in Peru with varying degrees of urbanization, altitude, and biomass fuel use. Methods We collected sociodemographics, clinical history, and post-bronchodilator spirometry in a randomly selected, age-, sex- and site-stratified, population-based sample of 2,957 adults aged ≥35 years (median age was 54.8 years and 49.3% were men) from four resource-poor settings: Lima, Tumbes, urban and rural Puno. We defined COPD as a post-bronchodilator FEV1/FVC < 70%. Results Overall prevalence of COPD was 6.0% (95% CI 5.1%–6.8%) but with marked variation across sites: 3.6% in semi-urban Tumbes, 6.1% in urban Puno, 6.2% in Lima, and 9.9% in rural Puno (p < 0.001). Population attributable risks (PARs) of COPD due to smoking ≥10 pack-years were less than 10% for all sites, consistent with a low prevalence of daily smoking (3.3%). Rather, we found that PARs of COPD varied by setting. In Lima, for example, the highest PARs were attributed to post-treatment tuberculosis (16% and 22% for men and women, respectively). In rural Puno, daily biomass fuel for cooking among women was associated with COPD (prevalence ratio 2.22, 95% CI 1.02–4.81) and the PAR of COPD due to daily exposure to biomass fuel smoke was 55%. Conclusions The burden of COPD in Peru was not uniform and, unlike other settings, was not predominantly explained by tobacco smoking. This study emphasizes the role of biomass fuel use, and highlights pulmonary tuberculosis as an often neglected risk factor in endemic areas.
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Affiliation(s)
- Devan Jaganath
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD, 21205, USA. .,Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - J Jaime Miranda
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. .,Departamento de Medicina, Escuela de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Robert H Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Robert A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD, 21205, USA.
| | - Gregory B Diette
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD, 21205, USA.
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD, 21205, USA.
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD, 21205, USA.
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Moreira GL, Manzano BM, Gazzotti MR, Nascimento OA, Perez-Padilla R, Menezes AMB, Jardim JR. PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis. ACTA ACUST UNITED AC 2014; 40:30-7. [PMID: 24626267 PMCID: PMC4075910 DOI: 10.1590/s1806-37132014000100005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Graciane Laender Moreira
- Federal University of São Paulo, São Paulo, Brazil, Physiotherapist. Federal University of São Paulo, São Paulo, Brazil
| | - Beatriz Martins Manzano
- Federal University of São Paulo, São Paulo, Brazil, Physiotherapist. Federal University of São Paulo, São Paulo, Brazil
| | - Mariana Rodrigues Gazzotti
- São Camilo University Center, Department of Physical Therapy, São Paulo, Brazil, Professor. Department of Physical Therapy, São Camilo University Center, São Paulo, Brazil
| | - Oliver Augusto Nascimento
- Federal University of São Paulo, Department of Pulmonology, São Paulo, Brazil, Attending Physician, Department of Pulmonology, Federal University of São Paulo, São Paulo, Brazil
| | - Rogelio Perez-Padilla
- Instituto Nacional de Enfermedades Respiratórias, Mexico City, Mexico, Professor. Instituto Nacional de Enfermedades Respiratórias, Mexico City, Mexico
| | - Ana Maria Baptista Menezes
- Federal University of Pelotas, School of Medicine, Department of Clinical Medicine, Pelotas, Brazil, Full Professor of Pulmonology. Department of Clinical Medicine, Federal University of Pelotas School of Medicine, Pelotas, Brazil
| | - José Roberto Jardim
- Federal University of São Paulo, Department of Pulmonology, São Paulo, Brazil, Tenured Professor. Department of Pulmonology, Federal University of São Paulo, São Paulo, Brazil
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Oliveira PDD, Menezes AMB, Bertoldi AD, Wehrmeister FC. Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil. J Bras Pneumol 2014; 39:287-95. [PMID: 23857689 PMCID: PMC4075837 DOI: 10.1590/s1806-37132013000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.
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de Deus Chaves R, Chiarion Sassi F, Davison Mangilli L, Jayanthi SK, Cukier A, Zilberstein B, Furquim de Andrade CR. Swallowing transit times and valleculae residue in stable chronic obstructive pulmonary disease. BMC Pulm Med 2014; 14:62. [PMID: 24739506 PMCID: PMC4004463 DOI: 10.1186/1471-2466-14-62] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/11/2014] [Indexed: 01/30/2023] Open
Abstract
Background Breathing and swallowing are physiologically linked to ensure effortless gas exchange during oronasal breathing and to prevent aspiration during swallowing. Studies have indicated consistent aspiration in chronic obstructive pulmonary disease, mainly related to delayed swallowing reflex and problems with lingual propulsion and pharyngeal peristalsis as a result of bilateral weakness and incoordination of the related muscles. The purpose of the present study was to evaluate swallowing transit times and valleculae residue characteristics of stable COPD patients who have no swallowing complaints. Methods Our study population included 20 stable patients with COPD and no swallowing complaints and 20 healthy controls. Swallowing was assessed through videofluoroscopic examination and involved the analysis of the following parameters: (1) pharyngeal stages of deglutition; (2) the duration of bolus movement through the oral cavity and pharynx (i.e. transit times); (3) valleculae residue ratio; (4) penetration/aspiration. Results Participants of the study did not present any signs of penetration-aspiration for any of the tested consistencies. Patients with COPD presented longer pharyngeal transit times during the ingestion of the liquid consistency and during the ingestion of the paste consistency. Regarding the duration of tongue base contact with the posterior pharyngeal wall, COPD patients also presented longer durations for the liquid and paste consistencies. No significant difference was observed for the distribution of individuals among the different valleculae residue severity levels. Conclusions Our study suggests that stable COPD patients may present physiological adaptations as a protective swallowing maneuver to avoid aspiration/penetration of pharyngeal contents. Moreover, valleculae residue cannot be seen as an isolated factor when trying to explain swallowing alterations in this population.
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Affiliation(s)
| | | | | | | | | | | | - Claudia Regina Furquim de Andrade
- Department of Physiotherapy, Speech-language and Hearing Sciences, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Ovídeo Pires de Campos, 186, Cerqueira César, CEP 054030-010 São Paulo, SP, Brazil.
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Moreira MAC, Barbosa MA, Queiroz MCDCAMD, Teixeira KISS, Torres PPTES, Santana Júnior PJD, Montadon Júnior ME, Jardim JR. Pulmonary changes on HRCT scans in nonsmoking females with COPD due to wood smoke exposure. J Bras Pneumol 2013; 39:155-63. [PMID: 23670500 PMCID: PMC4075828 DOI: 10.1590/s1806-37132013000200006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 02/14/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To identify and characterize alterations seen on HRCT scans in nonsmoking females with COPD due to wood smoke exposure. METHODS: We evaluated 42 nonsmoking females diagnosed with wood smoke-related COPD and 31 nonsmoking controls with no history of wood smoke exposure or pulmonary disease. The participants completed a questionnaire regarding demographic data, symptoms, and environmental exposure. All of the participants underwent spirometry and HRCT of the chest. The COPD and control groups were adjusted for age (23 patients each). RESULTS: Most of the patients in the study group were diagnosed with mild to moderate COPD (83.3%). The most common findings on HRCT scans in the COPD group were bronchial wall thickening, bronchiectasis, mosaic perfusion pattern, parenchymal bands, tree-in-bud pattern, and laminar atelectasis (p < 0.001 vs. the control group for all). The alterations were generally mild and not extensive. There was a positive association between bronchial wall thickening and hour-years of wood smoke exposure. Centrilobular emphysema was uncommon, and its occurrence did not differ between the groups (p = 0.232). CONCLUSIONS: Wood smoke exposure causes predominantly bronchial changes, which can be detected by HRCT, even in patients with mild COPD.
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Moreira MAC, Barbosa MA, Jardim JR, Queiroz MCC, Inácio LU. Chronic obstructive pulmonary disease in women exposed to wood stove smoke. Rev Assoc Med Bras (1992) 2013; 59:607-13. [PMID: 24211014 DOI: 10.1016/j.ramb.2013.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 04/09/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To identify respiratory symptoms and COPD (forced vital capacity and forced expiratory volume in one second ratio < 0.70 and below the lower limit of normal) in non-smoking women with history of exposure to wood smoke of at least 80 hours-years. METHODS One hundred sixty nonsmoking women were included. Demographic data and information about symptoms and other environmental exposures were collected. All women underwent spirometry and those with COPD also had their lung volumes measured. RESULTS The COPD group had greater exposure in years to wood smoke (p = 0.043), greater length of rural residence (p = 0.042) and the same length of passive smoking (p = 0.297) and farm work (p = 0.985). Cough (69.8%), sputum (55.8%) and wheezing (67.4%) predominated in the COPD group (p < 0.001) compared to those without COPD (40.2%, 27.4%, 33, 3%, respectively). The COPD patients had mild to moderate obstructive disturbance and normal lung volumes, except that the residual volume and total lung capacity ratio (RV/TLC) > 0.40 in 45%, which correlated negatively with forced expiratory volume in one second (FEV1) and FEV1/vital forced capacity ratio (FEV1/FVC). CONCLUSION Women with prolonged exposure to wood smoke had predominantly mild to moderate COPD. Those without COPD had a high prevalence of chronic respiratory symptoms, justifying clinical and spirometric monitoring.
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Carvalho AK, Menezes AMB, Camelier A, Rosa FW, Nascimento OA, Perez-Padilla R, Jardim JR. Prevalence of self-reported chronic diseases in individuals over the age of 40 in São Paulo, Brazil: the PLATINO study. CAD SAUDE PUBLICA 2013; 28:905-12. [PMID: 22641513 DOI: 10.1590/s0102-311x2012000500009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/14/2011] [Indexed: 11/21/2022] Open
Abstract
Few studies have been conducted to determine the prevalence of chronic diseases and its impact in individuals aged 40 years or over in Brazil. The objective of this study is to evaluate the prevalence of some common chronic diseases in the Brazilian subgroup assessed by the PLATINO study using a self-reported survey. A total of 918 individuals (55% women) with a mean age of 54.6 ± 10.9 years were evaluated. The most prevalent diseases were obesity (62.5%), hypertension (39.2%) and gastritis (30.9%). We conclude from this study that there is a high prevalence of chronic diseases in the population over 40 years of age: 88% of the population suffers from a minimum of one disease and 26% of the sample suffers from at least three diseases. We also observed that the number of comorbidities increases with age.
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Ruas G, Ribeiro GG, Naves JM, Jamami M. The influence of body composition assessed by dual-energy x-ray absorptiometry on functional capacity of patients with chronic obstructive pulmonary disease. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: The individual with chronic obstructive pulmonary disease (COPD) can experience a significant reduction of body composition, peripheral muscle dysfunction, resulting in a negative influence on functional capacity. OBJECTIVES: To analyze the influence of body composition assessed by dual-energy x-ray absorptiometry on functional capacity of patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Eleven male patients with COPD (COPDG), seven presenting moderate obstruction and four severe, and 11 sedentary male subjects (CG) were evaluated by dual-energy x-ray absorptiometry to assess their body composition. All subjects also performed the 6-minute walk test (6MWT) and Step Test (6MST) to assess their functional capacity. RESULTS: No significant differences were found between groups for anthropometric data such as age, weight, height and body mass index (BMI). However, the COPDG presented Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio, Maximal Voluntary Ventilation (MVV), Walked Distance (WD) and Number of Steps (NS) significantly lower than the CG (p < 0.05, Student's t-test). The Body Bone Mass (BBM), BBM%, Lean Mass (LM), LM%, and Right Lower Limb (RLL) and Left Lower Limb (LLL) were significantly lower in the COPDG when compared with the CG, presenting statistically significant positive correlations with 6MWT's WD and 6MST's NS (p < 0.05, Pearson's test). CONCLUSION: We conclude that body composition is an important prognostic factor for patients with COPD, which reinforces the importance of assessing body composition by dual-energy absorptiometry since it has demonstrated with satisfactory accuracy in clinical practice. Moreover, it is a useful parameter for evaluation and reassessment in pulmonary rehabilitation programs.
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Athanazio R. Airway disease: similarities and differences between asthma, COPD and bronchiectasis. Clinics (Sao Paulo) 2012; 67:1335-43. [PMID: 23184213 PMCID: PMC3488995 DOI: 10.6061/clinics/2012(11)19] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 11/18/2022] Open
Abstract
Airway diseases are highly prevalent worldwide; however, the prevalence of these diseases is underestimated. Although these diseases present several common characteristics, they have different clinical outcomes. The differentiation between asthma, chronic obstructive pulmonary disease and bronchiectasis in the early stage of disease is extremely important for the adoption of appropriate therapeutic measures. However, because of the high prevalence of these diseases and the common pathophysiological pathways, some patients with different diseases may present with similar symptoms. The objective of this review is to highlight the similarities and differences between these diseases in terms of the risk factors, pathophysiology, symptoms, diagnosis and treatment.
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Affiliation(s)
- Rodrigo Athanazio
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, São Paulo, SP, Brazil.
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Fiori NS, Gonçalves H, Dumith SC, Cesar MADC, Menezes AMB, Macedo SEC. Ten-year trends in prevalence of asthma in adults in southern Brazil: comparison of two population-based studies. CAD SAUDE PUBLICA 2012; 28:135-44. [PMID: 22267073 DOI: 10.1590/s0102-311x2012000100014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 06/27/2011] [Indexed: 11/22/2022] Open
Abstract
There are discrepancies in the literature regarding time trends in the occurrence of asthma in adults. This study compared asthma prevalence in two cross-sectional studies with a ten-year interval in Pelotas, Rio Grande do Sul State, Brazil. The first, in 2000, included 1,968 individuals, and the second, in 2010, 2,466 adults (20-69 years). Prevalence of wheezing and shortness of breath in the prior 12 months remained the same after ten years (6% and 6.1%, respectively). In both studies, asthma was more frequent among females and people with low family income. Physician-diagnosed asthma increased by 35.6%, and lifetime incidence of asthma, by 32.2%. There was no percentage change in current asthma symptoms or current asthma. Local socioeconomic improvement between the two studies was consistent with the increase in medical diagnosis, but did not reflect better management of asthma symptoms, underlining the need for investment regarding other determinants of the disease.
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Affiliation(s)
- Nadia Spada Fiori
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil.
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Akgün KM, Crothers K, Pisani M. Epidemiology and management of common pulmonary diseases in older persons. J Gerontol A Biol Sci Med Sci 2012; 67:276-91. [PMID: 22337938 DOI: 10.1093/gerona/glr251] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pulmonary disease prevalence increases with age and contributes to morbidity and mortality in older patients. Dyspnea in older patients is often ascribed to multiple etiologies such as medical comorbidities and deconditioning. Common pulmonary disorders are frequently overlooked as contributors to dyspnea in older patients. In addition to negative impacts on morbidity and mortality, quality of life is reduced in older patients with uncontrolled, undertreated pulmonary symptoms. The purpose of this review is to discuss the epidemiology of common pulmonary diseases, namely pneumonia, chronic obstructive pulmonary disease, asthma, lung cancer, and idiopathic pulmonary fibrosis in older patients. We will review common clinical presentations for these diseases and highlight differences between younger and older patients. We will also briefly discuss risk factors, treatment, and mortality associated with these diseases. Finally, we will address the relationship between comorbidities, pulmonary symptoms, and quality of life in older patients with pulmonary diseases.
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Affiliation(s)
- Kathleen M Akgün
- Pulmonary and Critical Care Section, Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, USA.
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Sousa CAD, César CLG, Barros MBDA, Carandina L, Goldbaum M, Pereira JCR. Doença pulmonar obstrutiva crônica e fatores associados em São Paulo, SP, 2008-2009. Rev Saude Publica 2011; 45:887-96. [DOI: 10.1590/s0034-89102011005000051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 05/04/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estimar a prevalência e fatores associados à doença pulmonar obstrutiva crônica. MÉTODOS: Estudo transversal, de base populacional com 1.441 indivíduos de ambos os sexos e com 40 anos de idade ou mais no município de São Paulo, SP, entre 2008 e 2009. As informações foram coletadas por meio de entrevistas domiciliares e os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade, e por conglomerados em dois estágios (setores censitários e domicílios). Foi realizada regressão múltipla de Poisson na análise ajustada. RESULTADOS: Dos entrevistados, 4,2% (IC95% 3,1;5,4) referiram doença pulmonar obstrutiva crônica. Após análise ajustada, identificaram-se os seguintes fatores independentemente associados ao agravo: número de cigarros fumados na vida (> 1.500/nenhum) RP = 3,85 (IC95%: 1,87;7,94), cansar-se com facilidade (sim/não) RP = 2,61 (IC95% 1,39;4,90), idade (60 a 69 anos/50 a 59 anos) RP = 3,27 (IC95% 1,01;11,24), idade (70 anos e mais/50 a 59 anos) RP = 4,29 (IC95% 1,30;14,29), problemas de saúde nos últimos 15 dias (sim/não) RP = 1,31 (IC95% 1,02;1,77), e atividade física no tempo livre (sim/não) RP = 0,57 (IC95% 0,26;0,97). CONCLUSÕES: A prevalência da doença pulmonar obstrutiva crônica é elevada e está associada ao uso do tabaco e idade acima de 60 anos. Os problemas de saúde freqüentes e redução da atividade física no tempo livre podem ser considerados conseqüências dessa doença.
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Forey BA, Thornton AJ, Lee PN. Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema. BMC Pulm Med 2011; 11:36. [PMID: 21672193 PMCID: PMC3128042 DOI: 10.1186/1471-2466-11-36] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 06/14/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB) and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices. METHODS Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics. RESULTS Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28), current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41) and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94). For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited data show risk decreases with increasing starting age for COPD and CB and with increasing quitting duration for COPD. No clear relationship is seen with duration of smoking. CONCLUSIONS The results confirm and quantify the causal relationships with smoking.
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Affiliation(s)
| | | | - Peter N Lee
- P N Lee Statistics and Computing Ltd, Sutton, Surrey, UK
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Hu G, Zhou Y, Tian J, Yao W, Li J, Li B, Ran P. Risk of COPD From Exposure to Biomass Smoke. Chest 2010; 138:20-31. [DOI: 10.1378/chest.08-2114] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Souza MLDM, Meneghini AC, Ferraz E, Vianna EO, Borges MC. Knowledge of and technique for using inhalation devices among asthma patients and COPD patients. J Bras Pneumol 2010; 35:824-31. [PMID: 19820807 DOI: 10.1590/s1806-37132009000900002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 05/19/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate knowledge of and techniques for using prescribed inhalation devices among patients with asthma or COPD treated at a tertiary teaching hospital. METHODS Patients were assessed after medical visits, and their physicians were blinded to this fact. Patients were asked to demonstrate their inhaler technique and were then interviewed regarding their knowledge of inhalation devices, control of the disease and instructions received during medical visits. RESULTS We included 120 volunteers: 60 with asthma and 60 with COPD. All of the asthma patients and 98.3% of the COPD patients claimed to know how to use inhaled medications. In the sample as a whole, 113 patients (94.2%) committed at least one error when using the inhalation device. Patients committed more errors when using metered-dose inhalers than when using the dry-powder inhalers Aerolizer (p < 0.001) or Pulvinal (p < 0.001), as well as committing more errors when using the Aerolizer inhaler than when using the Pulvinal inhaler (p < 0.05). Using the metered-dose, Pulvinal and Aerolizer inhalers, the COPD group patients committed more errors than did the asthma group patients (p = 0.0023, p = 0.0065 and p = 0.012, respectively). CONCLUSIONS Although the majority of the patients claimed to know how to use inhalation devices, the fact that 94.2% committed at least one error shows that their technique was inappropriate and reveals a discrepancy between understanding and practice. Therefore, it is not sufficient to ask patients whether they know how to use inhalation devices. Practical measures should be taken in order to minimize errors and optimize treatment.
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Yang L, Zhou M, Smith M, Yang G, Peto R, Wang J, Boreham J, Hu Y, Chen Z. Body mass index and chronic obstructive pulmonary disease-related mortality: a nationally representative prospective study of 220,000 men in China. Int J Epidemiol 2010; 39:1027-36. [PMID: 20400495 DOI: 10.1093/ije/dyq051] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) in populations where many are overweight. Substantial uncertainty remains about the relationship in populations with lower mean BMI levels, and about the relevance to it of the effects of smoking or of reverse causality. METHODS A nationally representative prospective cohort study included 221,194 Chinese men aged 40-79 years in 1990-91, who were followed up for 15 years or to the age of 80 years. Hazard ratios for COPD-related mortality vs baseline BMI were adjusted for age, smoking, drinking and other factors. To reduce reverse causality, main analyses excluded all men with prior history of any respiratory diseases or abnormal lung function at baseline, leaving 2960 COPD-related deaths (16% of all deaths). RESULTS The mean baseline BMI was 21.7 kg/m(2). There was a highly significant inverse association between BMI and COPD-related mortality among men without any apparent impairment of lung function. Approximately 90% of men had a baseline BMI <25 kg/m(2), and among them, 5 kg/m(2) lower BMI was associated with 31% (95% confidence interval 18-45%) higher COPD-related mortality. The excess risk persisted after restricting the analysis to never-smokers or excluding the first 5 years of follow-up. CONCLUSIONS Low BMI is associated with increased COPD mortality in a relatively lean adult male population in China where COPD is one of the most common causes of death.
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Affiliation(s)
- Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK.
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Cavalcante AGDM, Bruin PFCD. O papel do estresse oxidativo na DPOC: conceitos atuais e perspectivas. J Bras Pneumol 2009; 35:1227-37. [DOI: 10.1590/s1806-37132009001200011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/18/2009] [Indexed: 12/12/2022] Open
Abstract
A DPOC é uma causa importante de morbidade e mortalidade em escala global. As manifestações clínicas e funcionais da DPOC resultam de danos pulmonares provocados por um conjunto de mecanismos, incluindo o estresse oxidativo, a inflamação, o desequilíbrio do sistema protease-antiprotease e a apoptose. O estresse oxidativo é central na gênese da DPOC, pois além de provocar dano direto às estruturas pulmonares, amplifica os demais mecanismos. Os eventos celulares e moleculares responsáveis pelo dano pulmonar antecedem em muito a expressão clínica e funcional da DPOC. Os broncodilatadores, principais drogas empregadas atualmente no tratamento da DPOC, não são eficazes em reduzir a progressão da doença. Avanços na compreensão da patogênese da DPOC aliados a esforços renovados na pesquisa básica e clínica deverão permitir sua detecção na fase pré-clínica e possibilitar um monitoramento mais adequado de sua atividade, além de permitir a introdução de novas modalidades de agentes terapêuticos capazes de impedir eficazmente sua progressão.
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Leitão Filho FS, Galduróz JCF, Noto AR, Nappo SA, Carlini EA, Nascimento OA, Santos SR, Jardim JR. Levantamento randomizado sobre a prevalência de tabagismo nos maiores municípios do Brasil. J Bras Pneumol 2009; 35:1204-11. [DOI: 10.1590/s1806-37132009001200007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 08/04/2009] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Ana Regina Noto
- Centro Brasileiro de Informações sobre Drogas Psicotrópicas, Brasil
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Indoor air pollution as a lung health hazard: focus on populous countries. Curr Opin Pulm Med 2009; 15:158-64. [PMID: 19532032 DOI: 10.1097/mcp.0b013e3283218304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Indoor air pollution (IAP) resulting from the use of solid fuel for cooking and heating is a significant public health concern in developing countries. Recent studies have attempted to better characterize the epidemiology of IAP in respiratory diseases and develop technologies for reducing this IAP exposure. RECENT FINDINGS Evidence showed that IAP resulting from solid fuel smoke is a causative or contributory factor to acute respiratory infection, chronic obstructive lung disease, asthma, lung cancer and tuberculosis. Evidence also showed that health education, improvements in household ventilation and area distribution, improvements in stoves and changes of the fuels for cooking and heating can reduce IAP. SUMMARY Evidence of impacts of IAP on respiratory system disease is strong. Although some technologies can improve indoor air quality in households, improving it in households is still an urgent and high-priority task. Longitudinal studies using different methods of exposure assessment that include both chemical measurements and activity data, with longer follow-up and larger samples, are needed. Any program for the prevention of IAP must be based on what is acceptable to the community, and the effects of the intervention must be evaluated.
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Godoy RFD, Teixeira PJZ, Becker Júnior B, Michelli M, Godoy DVD. Long-term repercussions of a pulmonary rehabilitation program on the indices of anxiety, depression, quality of life and physical performance in patients with COPD. J Bras Pneumol 2009; 35:129-36. [PMID: 19287915 DOI: 10.1590/s1806-37132009000200005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 07/17/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the 24-month effects of a pulmonary rehabilitation program (PRP) on anxiety, depression, quality of life and physical performance of COPD patients. METHODS Thirty patients with COPD (mean age, 60.8 +/- 10 years; 70% males) participated in a 12-week PRP, which included 24 physical exercise sessions, 24 respiratory rehabilitation sessions, 12 psychotherapy sessions and 3 educational sessions. All patients were evaluated at baseline (pre-PRP), at the end of the treatment (post-PRP) and two years later (current) by means of four instruments: the Beck Anxiety Inventory; the Beck Depression Inventory; Saint George's Respiratory Questionnaire; and the six-minute walk test (6MWT). RESULTS The comparison between the pre-PRP and post-PRP values revealed a significant decrease in the levels of anxiety (pre-PRP: 10.7 +/- 6.3; post-PRP: 5.5 +/- 4.4; p = 0.0005) and depression (pre-PRP: 11.7 +/- 6.8; post-PRP: 6.0 +/- 5.8; p = 0.001), as well as significant improvements in the distance covered on the 6MWT (pre-PRP: 428.6 +/- 75.0 m; post-PRP: 474.9 +/- 86.3 m; p = 0.03) and the quality of life index (pre-PRP: 51.0 +/- 15.9; post-PRP: 34.7 +/- 15.1; p = 0.0001). There were no statistically significant differences between the post-PRP and current evaluation values. CONCLUSIONS The benefits provided by the PRP in terms of the indices of anxiety, depression and quality of life, as well as the improved 6MWT performance, persisted throughout the 24-month study period.
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Affiliation(s)
- Rossane Frizzo de Godoy
- Departamento de Psicologia, Instituto de Medicina do Esporte, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
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Silva DR, Gazzana MB, Barreto SSM, Knorst MM. Idiopathic pulmonary fibrosis and emphysema in smokers. J Bras Pneumol 2009; 34:779-86. [PMID: 19009210 DOI: 10.1590/s1806-37132008001000005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 02/08/2008] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To describe the clinical and functional findings recently reported in the medical literature for patients diagnosed with emphysema involving the upper lobes and idiopathic pulmonary fibrosis (IPF) involving the lower lobes. METHODS Eleven patients with emphysema and IPF were identified retrospectively. All of the patients underwent high-resolution computed tomography of the lung and pulmonary function tests. RESULTS Of the 11 patients, 8 were male and 3 were female. The mean age was 70.7 +/- 7.2 years (range, 61-86 years). All of the patients were smokers (mean smoking history, 61.5 +/- 43.5 pack-years). The mean values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC were 72.1% +/- 12.7%, 68.2% +/- 11.9% and 74.4 +/- 10.8, respectively. Lung volumes were normal in 7 patients. A restrictive pattern was observed in 3 patients, and hyperinflation was present in one. The diffusing capacity was moderately-to-severely reduced in all of the patients (mean, 27.7% +/- 12.9% of predicted). Ten of the 11 patients performed the six-minute walk test. The mean distance covered was 358.4 +/- 143.1 m, and 9 of the 10 patients presented desaturation >or= 4%. Echocardiographic findings suggestive of pulmonary hypertension were present in 4 patients (mean systolic pulmonary artery pressure, 61.8 mmHg; range, 36-84 mmHg). CONCLUSIONS The concomitant presence of emphysema and IPF causes characteristic changes on pulmonary function tests. The most significant finding is a discrepancy between diffusing capacity and spirometry results.
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