Roberto Stirbulov

Avaliação da função pulmonar na obesidade graus I e II

BACKGROUND: Obesity can effect the thorax, diphragm and abdominal muscles, thereby resulting in altered respiratory function. OBJECTIVE: To evaluate the effects of obesity and to determine whether body mass index (BMI) and waist circumference correlate with spirometry values in obese individuals. METHOD: We studied 96 non-smokers of both sexes, 48 suffering from class I and class II obesity and ranging in age rom 18 to 75. All participants presented a BMI between 30 kg/m2 and 40 kg/m2 and none had a history of morbidity. Spirometry was performed, and waist circumferences were measured. RESULTS: No significant differences were found between the spirometric values of men with class I or II obesity and those of non-obese men. In obese women, forced vital capacity and forced expiratory volume in one second (FEV1) were significantly lower than in women who were not obese. Obese individuals of both sexes presented significantly lower expiratory reserve volume (ERV) than did non-obese individuals. Although inspiratory capacity was greater in obese men and women, the difference was significant only for the men. In obese men, there was a significant negative correlation, not seen in the women, between waist circumference and FEV1. CONCLUSION: Pulmonary function is altered in women suffering from class I and II obesity. In obese men, although pulmonary function is unaffected by BMI, we observed a significant negative correlation between BMI and ERV. We can conclude that pulmonary function is influenced by waist circumference in men suffering from class I and II obesity.

Guía de práctica clínica de la enfermedad pulmonar obstructiva crónica (EPOC) ALAT-2014: Preguntas y respuestas

ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.

Aplicação terapêutica da ventilação colateral com drenagem pulmonar no tratamento do enfisema pulmonar difuso: relato dos três primeiros casos

OBJECTIVEnTo report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage.nnnMETHODSnPatients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were selected for the evaluation of pulmonary drainage. During the pre- and post-operative periods, patients were submitted to plethysmography and six-minute walk tests, as well as completing the following quality of life questionnaires: Medical Outcomes Study 36-item Short-Form Health Survey, Saint Georges Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status and Medical Research Council Scale. In all three cases, the postoperative follow-up period was at least 300 days. The tests were performed at the following time points: during the pre-operative period; between post-operative days 30 and 40; and on post-operative day 300. Data were analyzed using profile plots of the means.nnnRESULTSnWhen the results obtained in the pre-operative period were compared to those obtained at the two post-operative time points evaluated, improvements were observed in all parameters studied.nnnCONCLUSIONSnThe results suggest that the surgical technique proposed for the treatment of patients suffering from severe diffuse emphysema successfully reduces the debilitating symptoms of these patients, improving their quality of life considerably.

Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study

Opportunistic chronic obstructive pulmonary disease (COPD) case finding approaches for high‐risk individuals with or without symptoms is a feasible option for disease identification. PUMA is an opportunistic case finding study conducted in primary care setting of Argentina, Colombia, Venezuela and Uruguay. The objectives were to measure COPD prevalence in an at‐risk population visiting primary care for any reason, to assess the yield of this opportunistic approach and the accuracy of a score developed to detect COPD.

Avaliação da função respiratória em indivíduos submetidos à abdominoplastia

BACKGROUND: To prospectively evaluate respiratory function using spirometric parameters in patients who underwent abdominal plastic surgery. METHODS: We studied 33 healthy non-smoking women that were submitted to abdominoplasty and presented normal results for thorax radiography made prior and four days after surgery. Spirometric tests were performed on the fourth, fifteenth and thirtieth day after surgery. RESULTS: Spirometric tests performed showed that, except for FEV1/FVC and FEF 25% - 75%/FVC, rewations, all other measured parameters (FVC, FEV, FEF 25% - 75% and PFE) were significantly decreased by the fourth postoperative day in relation to pre-surgical values. On the thirtieth post-surgery day FCV and PFE values were unsideted normal. Otherwise, FEV1 values were still significantly decreased compared to pre-surgical values even at the last evaluation. Spirometric tests evidenced that, except for the relation FEV1/FVC and FEF 25% - 75%/FVC, all other measured parameters (FVC, FEV, FEF 25% - 75% and PFE) were significantly decreased in the fourth post-surgery day in relation to presurgical values. FCV and PFE values were normal at the evaluation performed on the thirtieth post-surgery day. Otherwise, FEV1 values were still significantly decreased compared to pre-surgical values, even in the last evaluation. CONCLUSION: In conclusion, pulmonary function were significantly decreased in the fourth post-surgery day, with normalization at the thirtieth post-surgery day.

Respiratory repercussions of obesity

Obesity currently constitutes a serious public health challenge due to its increasing prevalence in the Brazilian population and its consequences as a causative factor of various systemic comorbidities. Studies have shown that obese patients present considerable functional-respiratory repercussions, which vary in intensity depending on the degree of obesity. Such repercussions include the following: decreased expiratory reserve volume (ERV); increased lower airway resistance; higher ratio between the residual volume and the total lung capacity (RV/TLC ratio); decreased pulmonary and thoracic compliance; decreased arterial oxygen pressure (PaO 2 ); increased arterial-alveolar oxygen difference; alveolar hypoventilation; and sleep disorders. In addition, the increase in the prevalence of dyspnea in obese patients is evident, and its intensity is directly proportional to the body mass index (BMI). The literature provides several explanations for the dyspnea seen in obese individuals. They can be subdivided as follows: • Mechanical disorders, such as elevation of the diaphragm by the increased abdominal volume, increased closing volume, and decreased compliance of the chest cavity. • Biochemical disorders, such as increased production of leptin, which is responsible for increasing lower airway resistance. • Respiratory disorders, such as alterations in the ventilation/perfusion ratio and increased oxygen consumption. However, we still do not have enough evidence to definitely determine the etiopathogenic factors of dyspnea in obese patients.

Detección de casos de EPOC en atención primaria en 4 países de Latinoamérica: metodología del Estudio PUMA

INTRODUCTIONnThe prevalence of COPD among patients treated in the healthcare system in Latin America is unknown. The PUMA study (Prevalencia y práctica habitUal -diagnóstico y tratamiento- en población de riesgo de EPOC en Médicos generalistas de 4 países de América Latina) screened at-risk patients attending primary care centers to evaluate the prevalence, diagnosis and treatment of COPD in this setting. The aim of this report is to describe the study methodology.nnnMETHODSnMulticenter, observational, cross-sectional study conducted in Argentina, Colombia, Uruguay and Venezuela. Subjects were≥40 years, smokers, former smokers and/or exposed to fossil fuels attending primary care centers. Eligible patients underwent pre- and post- bronchodilator spirometry and completed standardized questionnaires on demographics, smoking, exposure to environmental/domestic pollution, symptoms/history and management of respiratory diseases, comorbidities, and use of healthcare resources.nnnRESULTSnA total of 57 centers in 4 countries participated; 1,907 patients were included, 1,743 completed the PUMA questionnaire and 1,540 patients underwent validated spirometry.nnnCONCLUSIONSnWe describe the methodology used in the PUMA study, the first systematic multicenter study in four Latin American countries aimed at detecting COPD cases confirmed by spirometry in primary care. Approximately 90% of patients who completed the PUMA questionnaire underwent valid spirometry tests. This gives room for reflection on the feasibility of opportunistic screening at the primary care level to detect patients in the early stages of COPD or with undiagnosed COPD, and improve the diagnosis and management of this disease.

Doença pulmonar obstrutiva crônica ocupacional

Occupational chronic obstructive pulmonary disease, despite having been widely discussed for nearly half a century, is still rarely addressed in Brazil. Various studies, especially those that were population-based, have revealed the relationship between occupational exposure to aerosols and impairment of the airways. This chapter aims to remind physicians of the diagnosis of occupational chronic obstructive pulmonary disease by presenting a succinct review of the literature on the theme, which should be incorporated into the Global Initiative for Chronic Obstructive Lung Disease, in terms of the scope of the diagnostic basis as well as in terms of the questionnaire specific for the disease. Collecting detailed work histories and characterizing exposure to inhaled agents known to have deleterious effects on the respiratory system will surely result in improved approaches to making diagnoses and prognoses of this disease, as well as contributing to its greater control.Occupational chronic obstructive pulmonary disease, despite having been widely discussed for nearly half a century, is still rarely addressed in Brazil. Various studies, especially those that were population-based, have revealed the relationship between occupational exposure to aerosols and impairment of the airways. This chapter aims to remind physicians of the diagnosis of occupational chronic obstructive pulmonary disease by presenting a succinct review of the literature on the theme, which should be incorporated into the Global Initiative for Chronic Obstructive Lung Disease, in terms of the scope of the diagnostic basis as well as in terms of the questionnaire specific for the disease. Collecting detailed work histories and characterizing exposure to inhaled agents known to have deleterious effects on the respiratory system will surely result in improved approaches to making diagnoses and prognoses of this disease, as well as contributing to its greater control.

Chemotactic and Phagocytic Activity of Blood Neutrophils in Allergic Asthma

Allergic asthma is a chronic inflammatory airway disease, and has been considered a T helper-2-biased response. Studies suggest that neutrophils may be associated with exacerbation and asthma severity. We sought to evaluate the chemotactic activity and phagocytic capacity by peripheral blood neutrophils from individuals with controlled and uncontrolled allergic asthma, and compare the results with non-asthmatic controls groups. Blood neutrophils were isolated from 95 patients: 24 with controlled asthma, 24 uncontrolled asthma, 24 healthy subjects and 23 patients with IgE-mediated allergies other than asthma. The neutrophil chemotaxis, stimulated with LPS, autologous serum or homologous serum, was determined using Boyden chambers. The phagocytic capacity was assessed by ingestion of zimosan particles, and digestion phase was analyzed by NBT test. The phagocytic digestion phase and chemotaxis by neutrophils from asthmatic patients was higher than in non-asthmatic controls (pu2009u2009<u20090.05). Autologous serum-induced neutrophil chemotaxis in patients with uncontrolled asthma was greater (pu2009u2009<u20090.05) than in other study groups. The ingestion phase of phagocytosis showed similar values in asthmatics and non-asthmatics. We conclude that the blood neutrophil from controlled and uncontrolled asthmatic patients exhibit activation markers, particularly phagocytic digestion and chemotactic activities.

Influência da ascite na avaliação da função pulmonar em portadores de hipertensão portal

BACKGROUND: Oxygen deficiency in patients with portal hypertension may be secondary to changes in respiratory mechanics due to ascites. OBJECTIVES: Evaluate pulmonary function in patients with portal hypertension before and after reduction of the ascites. METHOD: Fifteen patients with portal hypertension and ascites were submitted to pulmonary function tests, comprising spirometry and arterial blood gas determination, before and after reduction of ascites. The analysed parameters were: forced vital capacity (FVC); forced expiratory volume in one second (FEV1); forced expiratory flow between 25-75% of the forced vital capacity (FEF 25-75%); expiratory reserve volume (ERV); FEV1/CVF; arterial oxygen pressure (PaO2); arterial carbon-dioxide pressure (PaCO2) and arterial oxygen saturation (SaO2). RESULTS: There was remarkable improvement in pulmonary volumes after decrease of ascites by treatment with diuretics associated or not to paracentesis. CONCLUSION: We concluded, that in patients with portal hypertension and ascites, there is a decrease of pulmonary volumes compared to predicted values, with significant improvement after decrease of ascites. Similarly, an increase of the arterial oxygen pressure and of the arterial oxygen saturation was perceived.