Ana Sofia Oliveira

COPD control: Can a consensus be found?

There are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD) or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of well-controlled disease, a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life. Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments.

Argon-plasma treatment in benign metastasizing leiomyoma of the lung: A case report

Benign metastasizing leiomyomas of the lung are rare smooth muscle cells tumours. We report the case of a 48 year-old female who was evaluated due to persistent cough, progressive dyspnoea and constitutional symptoms. Chest computed tomography revealed a left endobronchial mass, multiple parenchyma nodules and a pleural effusion. Bronchial biopsy histological features were consistent with benign metastasizing leiomyoma. The patient was successfully treated with argon-plasma and mechanical debulking. There was no disease relapse in the last four years.

Árgon-plasma no tratamento de leiomioma benigno metastizante pulmonar, um caso clínico

Benign metastasizing leiomyomas of the lung are rare smooth muscle cells tumours. We report the case of a 48 year-old female who was evaluated due to persistent cough, progressive dyspnoea and constitutional symptoms. Chest computed tomography revealed a left endobronchial mass, multiple parenchyma nodules and a pleural effusion. Bronchial biopsy histological features were consistent with benign metastasizing leiomyoma. The patient was successfully treated with argon-plasma and mechanical debulking. There was no disease relapse in the last four years.

The role of nocturnal oximetry in obstructive sleep apnoea-hypopnoea syndrome screening

AIMnThe aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry (NO) as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome (OSAHS), compared with polysomnography (PSG) as the gold standard.nnnMETHODOLOGYn63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease underwent PSG and NO. We then determined NO sensitivity, specificity, positive (PPV) and negative predictive values (NPV).nnnRESULTSnOSAHS was diagnosed in 47 patients with a mean age of 54 years. In the evaluation of the percentage of Total Sleep Time (TST) with oxygen desaturation below 90%, we found significant differences between patients with OSAHS (25.4 +/- 29.7%) and without OSAHS (1 +/- 1.5%), p< 0,001. We used two cutoff points to evaluate sensitivity, specificity, positive (PPV) and negative predictive values (NPV), based on the severity of O2 desaturation (StO < 90%). Using the first cutoff point we 2 diagnosed with NO as positive all the patients with TST desaturation values =1% of the TST. Under these circumstances we found a sensitivity of 76.6%, a specificity of 75%, a PPV of 90% and an NPV value of 52.2% for our screening test (NO). Using the second cutoff point, we diagnosed with NO as positive all the patients with TST desaturation values =5% of the TST. With this method we found a sensitivity of 65.9%, a specificity of 100%, a PPV of 100% and an NPV of 50%.nnnCONCLUSIONnNO is a useful screening test for the diagnosis of OSAHS in patients without respiratory disease.

Papel da oximetria nocturna no rastreio da síndroma de apneia-hipopneia obstrutiva do sono

Aim: The aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry (NO) as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome (OSAHS), compared with polysomnography (PSG) as the gold standard. n nMethodology: 63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease under-went PSG and NO. We then determined NO sensitivity, specificity, positive (PPV) and negative predictive values (NPV). n nResults: OSAHS was diagnosed in 47 patients with a mean age of 54 years. In the evaluation of the percentage of Total Sleep Time (TST) with oxygen desaturation below 90%, we found significant differences between patients with OSAHS (25.4 ± 29.7%) and without OSAHS (1 ± 1.5%), p < 0,001. We used two cutoff points to evaluate sensitivity, specificity, positive (PPV) and negative predictive values (NPV), based on the severity of O2 desaturation (StO2 < 90%). Using the first cutoff point we diagnosed with NO as positive all the patients with TST desaturation values ≥ 1% of the TST. Under these circumstances we found a sensitivity of 76.6%, a specificity of 75%, a PPV of 90% and an NPV value of 52.2% for our screening test (NO). Using the second cutoff point, we diagnosed with NO as positive all the patients with TST desaturation values ≥ 5% of the TST. With this method we found a sensitivity of 65.9%, a specificity of 100%, a PPV of 100% and an NPV of 50%. n nConclusion: NO is a useful screening test for the diagnosis of OSAHS in patients without respiratory disease. n nRev Port Pneumol 2007; XIII (4): 525-551

Identification and assessment of COPD exacerbations

Chronic Obstructive Pulmonary Disease (COPD) exacerbations play a central role in the disease natural history of the disease, affecting its overall severity, decreasing pulmonary function, worsening underlying co-morbidities, impairing quality of life (QoL) and leading to severe morbidity and mortality. Therefore, identification and correct assessment of COPD exacerbations is paramount, given it will strongly influence therapy success. For the identification of exacerbations, several questionnaires exist, with varying degrees of complexity. However, most questionnaires remain of limited clinical utility, and symptom scales seem to be more useful in clinical practice. In the assessment of exacerbations, the type and degree of severity should be ascertained in order to define the management setting and optimize treatment options. Still, a consensual and universal classification system to assess the severity and type of an exacerbation is lacking, and there are no established criteria for less severely ill patients not requiring hospital assessment. This might lead to under-reporting of minor to moderate exacerbations, which has an impact on patients health status. There is a clear unmet need to develop clinically useful questionnaires and a comprehensive system to evaluate the severity of exacerbations that can be used in all settings, from primary health care to general hospitals.

C20. Ventilação não invasiva (VNI) na exacerbação aguda (EA) grave da doença pulmonar obstrutiva crónica (DPOC) numa enfermaria

A utilizacao da VNI tem aumentado na ultima decada em doentes com insuficiencia respiratoria agudizada. Pretendeu-se avaliar o sucesso da VNI em doentes com acidemia respiratoria grave (pHxa0 Procedeu-se a um estudo retrospectivo, nos ultimos 30 meses, incluindo 28 doentes (79%homens), com DPOC em estadios III(79%) e IIB(7%), em oxigenoterapia domiciliaria 68% e ventilacao assistida domiciliaria 25%. A media etaria foi de 73 anos, 14% nao fumadores, maioritariamente internados atraves de urgencia central por infeccao respiratoria. Apos a instituicao de VNI, verificou-se sucesso em 82%(grupo1) e insucesso nos restantes (grupo2). Das gasometrias arteriais as 2 e 24 horas, objectivaram-se diferencas no comportamento nos grupos com normalizacao do pH e melhoria da hipoxemia mais precoce no grupo 1 (pxa0 Concluimos que o pH inicial nao foi factor determinante para o insucesso terapeutico contrariamente a recuperacao gasometrica nas primeiras 24 horas.

Smoking habits in young federated athletes

Tobacco is the major cause of sickness and preventable death, leading to the death of six million people annually worldwide. In Portugal, the prevalence of daily consumption of tobacco in individuals aged between 15 and 24 years old is 15.1%. Sports practice usually involves health benefits, associated with the establishment of rules and guidelines that promote good health behavior, such as smoking avoidance. In order to study the smoking habits of a population of young federated athletes in Portugal, to assess their knowledge about the effects of smoking on health and investigate the sources they use to get information about this topic, we conducted a cross-sectional study aimed to federated athletes in Portugal, aged between 16 and 24 years old. The rate of smokers was 17.6%. In what concerns the average number of cigarettes, 84.8% of smokers said they smoke 10 cigarettes per day and 64.6% consume on average 20 or fewer cigarettes per weekend. 73.4% of athletes believe that smoking affects their sports performance. Regarding the source of knowledge of the harm of tobacco, the Media and prevention campaigns are those that most affect athletes, with a response rate of 78.6% ans 89.7%, respectively. The high prevalence of federated athletes who smoke in the age group studied deserves special attention, since they serve as an example in society in general but do not seem to work as an example for themselves. It is very important the commitment and investment in smoking prevention in this particular group of the population, taking into account the age group and sports practice. We believe that specific education and smoking prevention strategies targeted to these specific population may result in a reduction of tobacco consumption.

C18. Docetaxel como quimioterapia de 2ª linha nos doentes com CPNPC: estudo prospectivo multicêntrico.

Durante cinco anos (1998-2002) foi realizado um estudo prospectivo com docetaxel (75xa0mg/m2 d1 3/3 semanas) como tratamento de 2a linha em doentes com CPNPC. Caracteristicas: sexoM/F:94/15; idade:58.6(33-74); SP£1:96(88%); histologia: adenocarcinoma-52,pavimento-celular-41; estadio IIIB/ IV:19/90. 94% tratados inicialmente com derivados da platina. Administrados 355 ciclos de docetaxel (3.3/doente). RP em 21 doentes (19.3% IC 95% 11.7-26.8) e estabilizacao em 36(33%). Ausencia de correlacao entre resultados com quimioterapia de 1a linha (taxa de resposta/intervalo ate progressao) e taxa de resposta ao docetaxel. Neutropenia grau ¾: 52 doentes (48%); 4:neutropenia febril; uma morte toxica. Efeitos adversos nao-hematologicos: alopecia (59%), astenia (28%) e polineuropatia (22%). Sobrevivencia mediana global: 12.7 meses, sobrevivencia posdocetaxel:6.1 meses, tempo ate progressao:12 semanas e taxas de sobrevivencia 1 e 2 anos:19 e 7%, respectivamente. Resultados positivos apesar de doentes maioritariamente quimioresistentes ou quimiorefractarios(>xa070%) e estadio IV(>xa080%). Conclui-se que a administracao de docetaxel em doentes com CPNPC e SP

C2. Pneumonia adquirida na comunidade (PAC) – influência da terapêutica com macrólidos ou novas fluoroquinolonas na evolução e duração de internamento

A necessidade de cobertura dos agentes atipicos na terapeutica inicial de doentes hospitalizados com PAC e um assunto controverso que pode ter relacao com a variacao regional na incidencia destes agentes. As Guidelines americanas mais recentes (ATS e IDSA), propoem na terapeutica empirica inicial da PAC a utilizacao de um macrolido ou de uma fluoroquinolona com actividade anti-pneumococica, de modo a cobrir sempre os agentes atipicos. Com o objectivo de compararmos a evolucao e duracao de internamento de doentes com PAC medicados com um beta-lactâmico associado a um macrolido ou uma nova quinolona (Grupo I) vs outros esquemas terapeuticos que nao incluissem qualquer cobertura para agentes atipicos (Grupo II), efectuamos um estudo retrospectivo com 180 doentes internados entre Dezembro de 2000 e Maio de 2002 no SPG com o diagnostico de PAC. No Grupo I incluimos 105 (58,3%) doentes e 75 (41,7%) no Grupo II. Nao encontramos diferencas com significado estatistico entre os dois grupos em relacao a idade, sexo, apresentacao clinica, patologia associada ou gravidade de apresentacao. Dos 14 doentes com evolucao desfavoravel, 50% pertenciam ao Grupo I e a duracao media de internamento neste grupo foi de 12,2 dias vs 13,7 dias no grupo II, nao se encontrando tambem diferencas com significado estatistico entre estes valores. Concluimos que a cobertura de agentes atipicos na terapeutica inicial da PAC pode nem sempre ser necessaria. Sera importante proceder a estudos prospectivos que ajudem a esclarecer esta questao e investiguem a distribuicao epidemiologica dos agentes atipicos no nosso pais.