Geruza Alves da Silva

Dyspnea scales in the assessment of illiterate patients with chronic obstructive pulmonary disease

BACKGROUND Multiple physiological, psychological, social and environmental factors may affect the perception of dyspnea. Although different scales have been used to record the severity of dyspnea in subjects with chronic obstructive pulmonary disease (COPD), none has reported evaluating the properties of such tools in illiterate patients. The objective of this study was to evaluate the reliability and features of concurrent validity of 4 dyspnea scales in illiterate (IL) subjects with COPD. METHODS One hundred COPD patients submitted to spirometry and were asked to score their breathlessness using a visual analogue scale (VAS), a numerical rating scale (NRS), the Borg scale (BS), and the basal dyspnea index (BDI). Each scale was presented to the patients before and after they had performed spirometry and measurement of residual volume. The obtained scores were analyzed according to the literacy status of the patients. RESULTS Thirty-three patients were classified as IL and 67 as literate (L). Both groups showed similar respiratory impairment and median scores of dyspnea (VAS, L = 45.0, IL = 49.0; NRS, L = 5.0, IL = 5.0; BS, L = 3.0, IL = 3.0; BDI, L = 5.0, IL = 4.0). No significant differences were found between the dyspnea scores obtained before and after spirometry for all scales in both groups. The degree of correlation between forced expiratory volume in 1 second (FEV1) and usual dyspnea evaluated by BDI did not show a statistical difference between the two groups (L, r = 0.37; IL, r = 0.51). CONCLUSION The employed dyspnea scales showed comparable reliability in both L and IL COPD subjects.

Sleep quality in noise exposed Brazilian workers

This study investigated the effect of chronic workplace exposure to excessive noise on sleep quality. It involved 40 male workers aged 33 to 50 years, 20 of whom had been exposed to environmental workplace noise levels of 85 dB or more on 40-hour-a-week jobs. Another 20 workers who were not exposed to excessive noise were used as controls. All subjects were interviewed and submitted to physical examination, pure tone and speech audiometry, immittance testing and nocturnal polysomnography. Comparative analysis demonstrated that the two groups were similar, except for the exposure to noise. Fishers test comparison of pure tone and speech audiometry and immittance testing revealed mild to moderate noise-induced hearing loss (P < 0.001) in the > or = 85-dB group. Indicators of sleep continuity were abnormal in both groups, demonstrating poor sleep quality; however, sleep quantity was normal. Of the 40 individuals, 13 (32.5%) presented respiratory sleep disorders. Of those 13, 10 presented daytime somnolence according to the Epworth Scale. The Mann-Whitney test showed that sleep was identical in the two groups. Fishers exact test revealed no association between altered sleep and hearing status in either group. Our results show that active men working 40-hour-a-week in the presence of excessive noise without adequate protection for more than eight years presented with noise-induced hearing loss but their quality or quantity of night sleep was unaffected. Sensori-neural deafness may represent an element of adaptation against noise during sleep.

Uso de descritores de dispneia desenvolvidos no Brasil em pacientes com doenças cardiorrespiratórias ou obesidade

OBJECTIVE: To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. METHODS: We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. RESULTS: The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rapido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiracao (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiracao clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiracao, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. CONCLUSIONS: In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.

Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe

Tuberculosis and cryptococcosis are infectious diseases that can result in the formation of single or multiple nodules in immunocompetent patients. Exposure to silica is known to raise the risk of infection with Mycobacterium tuberculosis. We report the case of an elderly man with no history of opportunistic infections and no clinical evidence of immunodeficiency but with a six-month history of dry cough and nocturnal wheezing. A chest X-ray revealed a mass measuring 5.0 × 3.5 cm in the right upper lobe. The diagnostic approach of the mass revealed tuberculosis. The histopathological analysis of the surrounding parenchyma reveled silicosis and cryptococcosis. Cryptococcosis was also found in masses identified in the mediastinal lymph nodes. The surgical approach was indicated because of the degree of pleuropulmonary involvement, the inconclusive results obtained with the invasive and noninvasive methods applied, and the possibility of malignancy. This case illustrates the difficulty inherent to the assessment of infectious or inflammatory pulmonary pseudotumors, the differential diagnosis of which occasionally requires a radical surgical approach. Despite the presence of respiratory symptoms for six months, the first chest X-ray was performed only at the end of that period. We discuss the possible pathogenic mechanisms that might have led to the combination of three types of granulomatous lesions in the same lobe, and we emphasize the need for greater awareness of atypical presentations of pulmonary tuberculosis.

Uso de descritores de dispneia traduzidos da língua inglesa em pacientes com doenças cardiorrespiratórias ou obesidade

OBJECTIVE: To investigate the usefulness of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) that were developed in English and translated to Brazilian Portuguese in patients with four distinct clinical conditions that can be accompanied by dyspnea. METHODS: We translated, from English to Brazilian Portuguese, a list of 15 dyspnea descriptors reported in a study conducted in the USA. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. RESULTS: The use of this set of descriptors led to a solution with nine clusters, designated expiracao (exhalation), fome de ar (air hunger), sufoco (suffocating), superficial (shallow), rapido (rapid), aperto (tight), falta de ar (shortness of breath), trabalho (work), and inspiracao (inhalation). Overlapping of the descriptors was quite common among the patients, regardless of their clinical condition. Asthma, COPD, and heart failure were significantly associated with the inspiracao cluster. Heart failure was also associated with the trabalho cluster, whereas obesity was not associated with any of the clusters. CONCLUSIONS: In our study sample, the application of dyspnea descriptors translated from English to Portuguese led to the identification of distinct clusters, some of which were similar to those identified in a study conducted in the USA. The translated descriptors were less useful than were those developed in Brazil regarding their ability to generate significant associations among the clinical conditions investigated here.

Pemberton Sign: A Recommendation to Perform Arm Elevation Spirometry With Flow-Volume Loops

We report a case of intrathoracic goiter with positive Pemberton sign. Conventional spirometry did not show abnormalities, but arm elevation spirometry with flow-volume loops revealed expiratory flow limitation with a plateau. Clinicians should consider repeating flow-volume loops with arm elevation in all cases of intrathoracic goiter with initially normal loops.