Rafaella Fagundes Xavier

Reversibility of impaired nasal mucociliary clearance in smokers following a smoking cessation programme

Background and objective:  Smoking cessation (SC) is recognized as reducing tobacco‐associated mortality and morbidity. The effect of SC on nasal mucociliary clearance (MC) in smokers was evaluated during a 180‐day period.

Short terms effects of air pollution from biomass burning in mucociliary clearance of Brazilian sugarcane cutters

Nasal mucociliary system is the first line of defense of the upper airways and may be affected acutely by exposure to particulate matter (PM) from biomass burning. Several epidemiologic studies have demonstrated a consistent association between levels of air pollution from biomass burning with increases in hospitalization for respiratory diseases and mortality. To determine the acute effects of exposure to particulate matter from biomass burning in nasal mucociliary transport by saccharin transit time (STT) test, we studied thirty-three non-smokers and twelve light smokers sugarcane cutters in two periods: pre-harvest season and 4 h after harvest at the first day after biomass burning. Lung function, exhaled carbon monoxide (CO), nasal symptoms questionnaire and mucociliary clearance (MC) were assessed. Exhaled CO was increased in smokers compared to non-smokers but did not change significantly after harvest. In contrast, STT was similar between smokers and non-smokers and decreased significantly after harvest in both groups (p < 0.001). Exposure to PM from biomass burning did not influence nasal symptoms. Our results suggest that acute exposure to particulate matter from sugarcane burned affects mucociliary clearance in smokers and non-smokers workers in the absence of symptoms.

Effects of Cigarette Smoking Intensity on the Mucociliary Clearance of Active Smokers

Background: Smoking impairs mucociliary clearance and increases respiratory infection frequency and severity in subjects with and without smoking-related chronic lung diseases. Objective: This study evaluated the effects of smoking intensity on mucociliary clearance in active smokers. Methods: Seventy-five active smokers were grouped into light (1-10 cigarettes/day; n = 14), moderate (11-20 cigarettes/day; n = 34) and heavy smokers (≥21 cigarettes/day; n = 27) before starting a smoking cessation programme. Smoking behaviour, nicotine dependence, pulmonary function, carbon monoxide in exhaled air (exCO), carboxyhaemoglobin (COHb) and mucociliary clearance measured by the saccharin transit time (STT) test were all evaluated. An age-matched non-smoker group (n = 24) was assessed using the same tests. Results: Moderate (49 ± 7 years) and heavy smokers (46 ± 8 years) had higher STT (p = 0.0001), exCO (p < 0.0001) and COHb (p < 0.0001) levels compared with light smokers (51 ± 15 years) and non-smokers (50 ± 11 years). A positive correlation was observed between STT and exCO (r = 0.4; p < 0.0001), STT and cigarettes/day (r = 0.3, p = 0.02) and exCO and cigarettes/day (r = 0.3, p < 0.01). Conclusion: Smoking impairs mucociliary clearance and is associated with cigarette smoking intensity.

Identifying COPD patients at risk for worse symptoms, HRQoL, and self-efficacy: A cluster analysis

Objectives To identify clusters of chronic obstructive pulmonary disease (COPD) patients with distinct beliefs about their illness in terms of symptoms, health-related quality of life (HRQoL), self-efficacy, and daily life physical activity (DLPA). Methods This cross-sectional study included 150 COPD outpatients. The patients’ illness perceptions, clinical control, HRQoL, self-efficacy, and DLPA (accelerometry) were evaluated. A cluster analysis was conducted using data from the Illness Perceptions Questionnaire - Revised to establish groups of patients with distinct illness perceptions. Differences between clusters were tested using a T-test or a Mann–Whitney U test. Results The cluster analysis revealed two groups: distressed (n = 95) and coping (n = 55). Despite the fact that both clusters presented similar pulmonary function, between-cluster differences were observed in their self-efficacy, dyspnea, HRQoL, clinical control (p < 0.001), and educational level (p = 0.002). The levels of DLPA did not differ between the clusters. Discussion We observed that clinically stable COPD patients who displayed higher emotional representations and less coherence had heightened symptoms, poorer HRQoL, worse self-efficacy, and lower educational levels. These results emphasize the need to routinely evaluate illness perceptions in COPD patients to target and tailor the proper treatment to improve these important health outcomes.

Reabilitação pulmonar no Brasil

Pulmonary rehabilitation (PR) was introduced in Brazil by Dr. José Roberto Jardim, around 1990, in a small room with two indoor exercise bicycles and a treadmill without at least inclination. Only in 1993 – that is, less than 25 years –, the Center for Rehabilitation in the Lar Escola São Francisco was funded, which is considered the first of the type in Brazil. There were four ergometric treadmills that steadily increased in number along with the number of attendances. This Center was the disseminator of respiratory physical therapists with training in PR. At the Clinics Hospital, of University of São Paulo, the RP appeared in 1998 due to the large number of patients and by the suggestion of Dr. Alberto Cukier. Nowadays, there are over 150 RP centers, many more than in other South American countries, such as Argentina (32), Colombia (12), Mexico (3), and Uruguay (2). There are South American countries that still rely on only one PR center, such as Paraguay, Bolivia, Venezuela, Costa Rica, Honduras, Peru, and Ecuador. With the evolution of the studies, it was widely demonstrated that PR reduces dyspnea, increases exercise capacity, and improves the quality of life in individuals with chronic obstructive pulmonary disease (COPD)1. These benefits became so established in the literature that Cochrane Library decided something quite unusual: they stopped accepting reviews on the subject2. This occurred because the conclusions of the latest update of the Cochrane on RP in patients with COPD agreed with previous versions, published in 1996, 2002, and 20063-6. The decision followed the Cochrane Handbook: “a review that is no longer being updated is the one that is highly susceptible to maintain its current relevance for a foreseeable future. Situations in which a review may be declared as no longer updated include: 1) the intervention is replaced, keeping in mind that the Cochrane reviews must be internationally relevant and 2) the conclusion is so correct that adding new information will not change it, and there are not predictable adverse effects of the intervention7”. Such reviews are classified in the Cochrane database of systematic reviews as being “stable.” New approaches to the study of PR in patients with COPD aim to understand how to modify the behavior. In this sense, the most recent definition of RP says that “PR is a comprehensive intervention based on a thorough evaluation, followed by therapies adapted to the patient that include, but are not limited to, physical training, education, and behavior change. It is designed to improve the physical and psychological condition of people with chronic respiratory diseases and to promote long-term adherence to behaviors that improve health8”. In this sense, the development of technologies that reduce the level of sedentary lifestyle or increase the level of physical activity is theme of topical interest. Despite the advances of PR, there are still at least four points to be improved. Firstly, increasing the access of patients to the PR in the whole world, including its effect in patients hospitalized for exacerbations, as well as evaluating its effectiveness in patients with smoother chronic respiratory disease. Secondly, developing alternative PR models, as the use of new technologies and telerehabilitation. Thirdly, putting into practice methods that encourage patients to change their behavior in a significant and sustainable way (self-management). And, finally, understanding the diversity and multisystemic complexity of COPD and other chronic respiratory diseases, including the different phenotypes of the disease and the impact of PR on these phenotypes. Let’s wait for new studies to see what is coming...