Luiz Carlos Corrêa da Silva

Sarcoidose no sul do Brasil : estudo de 92 pacientes

OBJECTIVE: This case study, conducted in the state of Rio Grande do Sul (RS), Brazil, aims to determine the local profile of sarcoidosis, describing patient characteristics, clinical presentation and pulmonary function, as well as analyzing the results of radiological, histopathological and biochemical tests, at the time of diagnosis in a series of sarcoidosis patients. METHODS: A retrospective study of 92 patients with sarcoidosis treated on the Pavilhao Pereira Filho (Pereira Filho [Respiratory Diseases] Ward) of the Hospital Santa Casa, in the city of Porto Alegre, RS, between 1990 and 2003. The protocol included the collection of clinical, biochemical, radiological, spirometric and histological data. RESULTS: There was no significant gender-based difference in frequency (men, 42%; women, 58%). Mean age was 41.8 ± 14.1 years, with 87% of patients being between 20 and 60 years old. Caucasians predominated (84%). Most patients (61%) had never smoked, 29% were former smokers, and 10% were current smokers. The majority (33%) of the diagnoses were made in winter. Among the clinical findings, it is of note that 12% were asymptomatic, 18% presented pulmonary symptoms only, 22% presented extrapulmonary symptoms only, and 48% presented pulmonary and extrapulmonary symptoms. Spirometry was performed in 79% of patients at the time of diagnosis. In 45% of those patients, abnormal results were obtained: a restrictive pattern was seen in 23%, an obstructive pattern in 18% and a mixed pattern in 4%. Classification by radiological type revealed that 30% were stage I, 48% were stage II, and 22% were stage III. CONCLUSION: The findings of this study are quite similar to those of other studies in the literature, particularly those conducted in Europe.

Controle do tabagismo: desafios e conquistas

O tabagismo e o fator de risco mais prevenivel e controlavel em saude e, por isso, precisa ter a maxima atencao e ser muito mais enfocado por todos os profissionais da saude. O tabaco e um produto de alta rentabilidade pela sua grande producao e pelo elevado numero de consumidores. As politicas de controle e os recursos terapeuticos para o tabagismo avancaram muito nos ultimos anos e tem mostrado resultados altamente satisfatorios, particularmente no Brasil. Entretanto, ainda resta um longo caminho a ser percorrido para que se possa considerar o tabagismo como uma doenca controlada sob o ponto de vista da saude publica. Ja se observam modificacoes do comportamento da sociedade com relacao ao tabagismo, mas ainda em escala muito lenta, de modo que os pneumologistas tem nesse setor um campo muito promissor para atuar junto a seus pacientes e a populacao em geral. E preciso atuar com maior impeto em prol das politicas de saude e das normas de convivio social que contribuem diretamente para melhorar a saude e a vida. Nesse aspecto, os pneumologistas podem ter um papel de maior destaque na medida em que se envolvam com o tratamento dos fumantes, a aplicacao da lei antifumo e as politicas de saude relacionadas as doencas respiratorias.

Smoking control: challenges and achievements.

ABSTRACT Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

Desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 em Porto Alegre, Brasil

OBJECTIVE To describe the outcomes of retreatment in tuberculosis patients receiving the regimen known, in Brazil, as regimen 3 (streptomycin, ethambutol, ethionamide, and pyrazinamide for 3 months + ethambutol and ethionamide for 9 months) after treatment failure with the basic regimen (rifampin, isoniazid, and pyrazinamide for 2 months + rifampin and isoniazid for 4 months). METHODS A descriptive, uncontrolled, historical cohort study involving adult tuberculosis patients treated with regimen 3. We evaluated adverse drug effects, recurrence, treatment outcomes, and associated factors. RESULTS The study included 229 patients. The overall cure rate was 62%. For the patients who used the medications regularly and those who did not, the cure rate was 88% and 31%, respectively. Adverse events occurred in 95 patients (41.5%), and most of those events were related to the gastrointestinal tract. In the five-year follow-up period, relapse occurred in 17 cases (12.0%). CONCLUSIONS Overall, the outcomes of treatment with regimen 3 were unsatisfactory, in part because this regimen was administered to a selected population of patients at high risk for noncompliance with treatment, as well as because it presents high rates of adverse effects, especially those related to the gastrointestinal tract, which might be caused by ethionamide. However, for those who took the medications regularly, the cure rate was satisfactory. The recurrence rate was higher than that recommended in international consensus guidelines, which might be attributable to the short (12-month) treatment period. We believe that regimen 3, extended to 18 months, represents an option for patients with proven treatment compliance.

Espirometria: o que é normal?

Nos dias atuais, mesmo com os avancos tecnologicos, ainda permanecem algumas dificuldades para conseguir tabelas de referencia adequadas. Algumas variaveis interferem no estabeleci-mento dos padroes de normalidade, tais como extremos etarios, ponderais ou de envergadura; diversidades etnicas e regionais; exposicoes individuais e coletivas a fatores ambientais; enfim, tudo o que possa influenciar a funcao pulmonar.Nas ultimas decadas, propuseram-se tabelas de norma-lidade provenientes de populacoes heterogeneas e sem criterios de inclusao uniformes na America do Norte e na Europa. Como os espirometros usados no Brasil sao geralmente importados e trazem incluidas as equacoes de valores normais previstos do pais de origem, estes refe-renciais tem sido usados na nossa rotina, especialmente a tabela de Knudson et al.

Efeito do salbutamol liberado através de inalador de pó seco sobre o broncoespasmo induzido por metacolina

INTRODUCAO: Os b2-agonistas de curta duracao sob a forma de nebulimetro pressurizado sao os farmacos utilizados rotineiramente na reversao do broncoespasmo induzido pela metacolina. A administracao desses farmacos na forma de po seco, liberados por inaladores de po seco pode ser uma alternativa eficaz. OBJETIVO: Avaliar a efetividade e rapidez de acao do salbutamol liberado atraves de inalador de po seco pulvinal (Butoventâ) na reversao do broncoespasmo induzido por metacolina, comparando-o com o salbutamol liberado por nebulimetro pressurizado. METODO: Foram avaliados prospectivamente 60 pacientes sucessivos com broncoespasmo induzido por metacolina, cuja queda do volume expiratorio forcado no primeiro segundo (VEF1) foi de, no minimo, 20%. Foram randomizados 30 pacientes para receber 200 mcg de salbutamol liberado por nebulimetro pressurizado e 30 pacientes para receber 200 mcg de salbutamol atraves de inalador de po seco (pulvinal), na etapa final do teste de broncoprovocacao, com o objetivo de reverter o broncoespasmo induzido pela metacolina. Foram avaliados os VEF1 obtidos 1 minuto e 5 minutos apos a administracao do broncodilatador. RESULTADOS: Os grupos foram pareados por sexo, idade, peso, altura, dose provocativa causadora de queda de 20% no VEF1 (primeiro grupo: 1,3 mg ; segundo grupo: 1,19 mg; p = 0,79) e VEF1 pos-metacolina (primeiro grupo: 2,03 l; segundo grupo: 1,99 l; p = 0,87), sem diferenca significativa entre eles. O incremento medio do VEF1 foi de 16,2% (1 minuto) e 22,2% (5 minutos) no primeiro grupo e de 17% (1 minuto) e 23,6% (5 minutos) no segundo grupo, nao havendo diferenca estatistica entre eles (p = 0,8). CONCLUSOES: Os b2-agonistas administrados atraves de inalador de po seco (pulvinal) apresentam a mesma eficacia broncodilatadora e rapidez de acao que no tradicional metodo por nebulimetro pressurizado.