Abordagem e tratamento do tabagismo / Approach and treatment of smoking

O Sistema Único de Saúde (SUS) tem papel fundamental no auxílio às pessoas que desejam parar de fumar. Para tanto, é muito importante que os profissionais atuantes na atenção básica e assistência à saúde estejam preparados para oferecer esse auxílio. Considerando esse contexto, a Diretoria de Vigilância Epidemiológica da Secretaria de Estado da Saúde de Santa Catarina (DIVE/SES/SC), por meio de sua Gerência de Análises Epidemiológicas e Doenças e Agravos Não Transmissíveis (GADNT) e a Escola de Saúde Pública de Santa Catarina (ESPSC) disponibilizam o curso "Abordagem e Tratamento do Tabagismo".

Brazilian guidelines for the pharmacological treatment of idiopathic pulmonary fibrosis. Official document of the Brazilian Thoracic Association based on the GRADE methodology.

Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.

Brazilian guidelines for the pharmacological treatment of idiopathic pulmonary fibrosis. Official document of the Brazilian Thoracic Association based on the GRADE methodology / Diretrizes brasileiras para o tratamento farmacológico da fibrose pulmonar idiopática. Documento oficial da Sociedade Brasileira de Pneumologia e Tisiologia baseado na metodologia GRADE

ABSTRACT Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.

RESUMO A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI.

Brazilian guidelines for the pharmacological treatment of idiopathic pulmonary fibrosis. Official document of the Brazilian Thoracic Association based on the GRADE methodology

Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.

Translation and cultural adaptation of the King's Brief Interstitial Lung Disease health status questionnaire for use in Brazil.

OBJECTIVE: To translate the King's Brief Interstitial Lung Disease (K-BILD) questionnaire to Portuguese and culturally adapt it for use in Brazil. The K-BILD quantifies the health status of patients with ILD. METHODS: The process involved the following steps: authorization from the author of the original (English-language) questionnaire; translation of the questionnaire to Portuguese by three translators, working independently; merging of the translations by a committee of specialists; back-translation of the questionnaire to English; revision and readjustment of the back-translation by the committee of specialists; evaluation by the original author; revision of the back-translation; cognitive debriefing (verification of the clarity and acceptability of the Portuguese-language version in the target population-i.e., patients with ILD); and finalization of the Portuguese-language version. RESULTS: In the cognitive debriefing step, 20 patients with ILD were interviewed. After the interviews, the clarity and acceptability index of each question was ≥ 0.8, which is considered acceptable. CONCLUSIONS: The Portuguese-language version of K-BILD appears to be easily administered to and understood by patients with ILD in Brazil. To our knowledge, this is the only instrument in Brazilian Portuguese that is designed to evaluate the impact that ILD has on the various aspects of the lives of those it affects.

Prevalence of smoking and reasons for continuing to smoke: a population-based study.

OBJECTIVE: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. METHODS: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. RESULTS: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). CONCLUSIONS: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.

How does the GINA definition of control correlate with quality of life and sputum cellularity?

Since 2014, the Global Initiative for Asthma (GINA) has stated that asthma control should be measured using four questions concerning diurnal and nocturnal symptoms, activity limitation, and rescue medication use. We assessed how asthma control by this definition correlates with airway inflammation and quality of life. 113 asthmatic subjects consecutively recruited from their routine clinical appointment underwent spirometry, sputum induction and answered the Standardised Asthma Quality of Life Questionnaire (AQLQ(S)) during a single visit. 43 (38.1%), 37 (32.7%) and 33 (29.2%) subjects had controlled asthma, partly controlled asthma and uncontrolled asthma, respectively. The majority of subjects with controlled asthma (67.4%) had paucigranulocytic sputum. Eosinophilic sputum was present in all levels of asthma control. Although most subjects with controlled asthma (58.1%) achieved an AQLQ(S) score ≥6 (minimal or no impairment), the remaining patients (41.9%) had moderate/some impairment (AQLQ(S) score <6 and ≥3) due to activity impairment and environmental exposure. The present GINA definition of current symptom control reflects control of airway inflammation. However, quality of life impairment can be present even in these patients. Measuring quality of life may provide useful information when evaluating asthma control.

Translation and cultural adaptation of the King's Brief Interstitial Lung Disease health status questionnaire for use in Brazil / Tradução e adaptação cultural do King's Brief Interstitial Lung Disease health status questionnaire

ABSTRACT Objective: To translate the King's Brief Interstitial Lung Disease (K-BILD) questionnaire to Portuguese and culturally adapt it for use in Brazil. The K-BILD quantifies the health status of patients with ILD. Methods: The process involved the following steps: authorization from the author of the original (English-language) questionnaire; translation of the questionnaire to Portuguese by three translators, working independently; merging of the translations by a committee of specialists; back-translation of the questionnaire to English; revision and readjustment of the back-translation by the committee of specialists; evaluation by the original author; revision of the back-translation; cognitive debriefing (verification of the clarity and acceptability of the Portuguese-language version in the target population-i.e., patients with ILD); and finalization of the Portuguese-language version. Results: In the cognitive debriefing step, 20 patients with ILD were interviewed. After the interviews, the clarity and acceptability index of each question was ≥ 0.8, which is considered acceptable. Conclusions: The Portuguese-language version of K-BILD appears to be easily administered to and understood by patients with ILD in Brazil. To our knowledge, this is the only instrument in Brazilian Portuguese that is designed to evaluate the impact that ILD has on the various aspects of the lives of those it affects.

RESUMO Objetivo: Traduzir e adaptar culturalmente o King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire, utilizado para mensurar o estado de saúde em pacientes com doença pulmonar intersticial (DPI), para a língua portuguesa falada no Brasil. Métodos: As seguintes etapas foram realizadas: autorização do autor do instrumento original; preparação; tradução do K-BILD da língua inglesa para a língua portuguesa falada no Brasil por três tradutores independentes; unificação das traduções por um comitê de especialistas; retradução do português para o inglês; revisão e readequação da retradução pelo comitê de especialistas; avaliação do autor do original; revisão da versão em inglês; desdobramento cognitivo (observação da clareza e aceitabilidade do questionário traduzido na população-alvo); e elaboração da versão final em português. Resultados: Na etapa de desdobramento cognitivo foram entrevistados 20 pacientes com DPI. Após todas as entrevistas, o índice de clareza e aceitabilidade das questões foi igual ou maior que 0,8, indicando um índice de clareza aceitável para todas as questões. Conclusões: A versão do K-BILD mostrou ser compreensível e de fácil aplicação. Até onde sabemos, esse é atualmente o único instrumento disponível em português falado no Brasil dirigido à avaliação do impacto da DPI em vários aspectos da vida desses pacientes.

Prevalence of smoking and reasons for continuing to smoke: a population-based study / Prevalência de tabagismo e motivos para continuar a fumar: estudo de base populacional

ABSTRACT Objective: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. Methods: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. Results: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). Conclusions: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.

RESUMO Objetivo: Investigar a prevalência de tabagismo e as razões para continuar a fumar em adultos no Brasil. Métodos: Estudo transversal de base populacional com 1.054 indivíduos com idade ≥ 40 anos residentes em Florianópolis (SC), dos quais 183 eram tabagistas. Todos os fumantes preencheram a Escala Razões para Fumar da Universidade de São Paulo (ERF-USP). Os sintomas de depressão foram avaliados por meio da Hospital Anxiety and Depression Scale, e a presença ou ausência de DPOC foi determinada por meio de espirometria. Resultados: Dos 183 fumantes, 105 (57,4%) eram do sexo feminino, 138 (75,4%) eram brancos e 125 (63,8%) pertenciam a uma classe econômica baixa. A média de escolaridade entre os fumantes foi de 9,6 ± 6,1 anos. A média de carga tabágica foi de 29 ± 15 anos-maço, e 59% dos homens apresentavam carga tabágica ≥ 30 anos-maço. Aproximadamente 20% dos fumantes apresentavam DPOC, e 29% apresentavam sintomas de depressão, mais comuns entre as mulheres. A pontuação obtida na ERF-USP foi maior nos domínios prazer de fumar (PF), redução da tensão (RT) e dependência física (DF): 3,9 ± 1,1; 3,6 ± 1,2 e 3,5 ± 1,3, respectivamente. A pontuação obtida nos domínios PF, RT e controle de peso (CP) foi significativamente maior entre as mulheres. Fumantes com carga tabágica > 20 anos-maço obtiveram pontuação significativamente maior nos domínios DF, PF, automatismo e associação estreita (AE). A carga tabágica relacionou-se com os domínios DF, PF, RT e AE. Sintomas de depressão relacionaram-se com os domínios DF, tabagismo social e AE (p = 0,001; p = 0,01; p = 0,09, respectivamente). Sexo feminino e baixa escolaridade relacionaram-se com os domínios PF (p = 0,04) e RT (p < 0,001). Conclusões: A prevalência de tabagismo em nossa amostra foi relativamente alta (17,4%). Os domínios PF, RT e CP da ERF-USP, bem como os sintomas de depressão, explicam por que os indivíduos continuam a fumar.

Câncer de pulmão: dados de três anos do registro hospitalar de câncer de um hospital do sul do Brasil / Lung cancer: three years of data hospital cancer registry of a Brazil south hospital

O Câncer de pulmão é uma neoplasia frequente. Na região sul, observam-se as maiores taxas de incidência e mortalidade relacionadas à doença no país. Objetivou-se avaliar o perfil dos pacientes com câncer de pulmão, atendidos no em um hospital do sul do Brasil. Como metodologia foi realizado um estudo retrospectivo, transversal, descritivo e analítico que utilizou o banco de dados do referido hospital, no período de 2007 a 2010. Analisou-se dados demográficos, socioeconômicos, características da neoplasia, diagnósticos e tratamentos.Foram avaliados dados de 103 pacientes com câncer de pulmão, com idade mediana de 65 anos, sexo masculino (71,8%), brancos (78,6%), com até primeiro grau incompleto (67%). O principal tipo histológico foi adenocarcinoma (24,3%). Não havia informação sobre o estadiamento em 48,5% dos pacientes. O estádio 4foi encontrado em 18,4% e apenas 10,7% apresentavam estadios precoces (I e II). A mediana dos dias entre primeira consulta e diagnóstico foi de 15 dias e entre o diagnóstico e o primeiro tratamento9dias. A principal forma de diagnóstico foi através de exame histológico do tumor primário (48,5%). Apenas 27,2% dos pacientes realizaram tratamento na própria instituição e 14,6% realizaram cirurgia de ressecção tumoral. A maioria (74,8%) não realizou nenhum tratamento no hospital. Observou-se uma tendência dos adenocarcinomasemse apresentarem em estadios precoces. Este hospital não realizou a maior parte do tratamento e nem o seguimento da maioria destes pacientes, mas desempenhou importante papel na investigação diagnóstica.

Lung cancer is a common cancer. In the southern region, are observed the highest incidence and mortality rates related to the disease in the country. The objective was to evaluate the profile of patients with lung cancer treated at a hospital in southern Brazil. The methodology was conducted a retrospective, cross-sectional, descriptive and analytical study using the Hospital database, from 2007 to 2010. We analyzed demographic, socioeconomic, tumor characteristics, diagnosis and treatment. Data were collected from 103 patients with lung cancer, with a median age of 65, male (71.8%), white (78.6%), with up to incomplete primary education (67%). The main histological type was adenocarcinoma (24.3%). There was no information about the staging in 48.5% of patients. The stadium 4foi found in 18.4% and only 10.7% had early stages (I and II). The median of days between the first visit and diagnosis was 15 days and between the first diagnosis and treatment 9dias. The main form of diagnosis was by histological examination of the primary tumor (48.5%). Only 27.2% of the patients underwent treatment at the institution and 14.6% underwent tumor resection. Most (74.8%) did not perform any treatment in the hospital. There was a tendency of adenocarcinomas in presenting themselves at early stages. This hospital did not perform most of the treatment nor the follow-up of most of these patients, but played an important role in diagnosis.

Translation and cultural adaptation of a specific instrument for measuring asthma control and asthma status: the Asthma Control and Communication Instrument / Tradução e adaptação cultural de um instrumento específico para medir o controle e estado da asma: Asthma Control and Communication Instrument

ABSTRACT Objective: To translate the Asthma Control and Communication Instrument (ACCI) to Portuguese and adapt it for use in Brazil. Methods: The ACCI was translated to Portuguese and adapted for use in Brazil in accordance with internationally accepted guidelines. The protocol included the following steps: permission and rights of use granted by the original author; translation of the ACCI from English to Portuguese; reconciliation; back-translation; review and harmonization of the back-translation; approval from the original author; review of the Portuguese version of the ACCI by an expert panel; cognitive debriefing (the clarity, understandability, and acceptability of the translated version being tested in a sample of the target population); and reconciliation and preparation of the final version. Results: During the cognitive debriefing process, 41 asthma patients meeting the inclusion criteria completed the ACCI and evaluated the clarity of the questions/statements. The clarity index for all ACCI items was > 0.9, meaning that all items were considered to be clear. Conclusions: The ACCI was successfully translated to Portuguese and culturally adapted for use in Brazil, the translated version maintaining the psychometric properties of the original version. The ACCI can be used in clinical practice because it is easy to understand and easily applied.

RESUMO Objetivo: Traduzir e adaptar culturalmente para a língua portuguesa falada no Brasil um instrumento que avalia a comunicação e o controle da asma, denominado Asthma Control and Communication Instrument (ACCI). Métodos: O ACCI foi traduzido e adaptado culturalmente com um protocolo que incluiu etapas internacionalmente aceitas: autorização e cessão de direitos de uso do ACCI de seu idealizador; tradução do ACCI da língua inglesa para a língua portuguesa; reconciliação; retradução; revisão e harmonização da retradução; aprovação do idealizador do ACCI; revisão da versão em português do ACCI por especialistas; desdobramento cognitivo (teste da clareza, compreensibilidade e aceitabilidade da versão traduzida em uma amostra da população-alvo) e reconciliação para a elaboração da versão final. Resultados: Na etapa do desdobramento cognitivo, foram entrevistados 41 indivíduos com asma que preencheram os critérios de inclusão. Todos responderam ao ACCI e avaliaram a clareza dos enunciados/questões e, para todos os itens, obteve-se um índice de clareza superior a 0,9, ou seja, todas as questões foram consideradas claras. Conclusões: A tradução e a adaptação cultural do ACCI para a língua portuguesa falada no Brasil foram bem-sucedidas e mantiveram as propriedades psicométricas do instrumento original. O ACCI pode ser utilizado na prática clínica por ser simples e de fácil compreensão e aplicação.

Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up. / Exacerbação de doença pulmonar obstrutiva crônica na unidade de terapia intensiva: avaliação clínica, funcional e da qualidade de vida na alta e após 3 meses de seguimento.

OBJECTIVE:: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. METHODS:: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. RESULTS:: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. CONCLUSION:: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.

Exacerbação de doença pulmonar obstrutiva crônica na unidade de terapia intensiva: avaliação clínica, funcional e da qualidade de vida na alta e após 3 meses de seguimento / Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up

RESUMO Objetivo: Avaliar aspectos clínicos e funcionais, assim como qualidade de vida de pacientes com doença pulmonar obstrutiva crônica após receberem alta da unidade de terapia intensiva à qual foram admitidos por insuficiência respiratória aguda. Métodos: Estudo prospectivo que incluiu pacientes com doença pulmonar obstrutiva crônica admitidos a duas unidades de terapia intensiva entre dezembro de 2010 e agosto de 2011, e que foram avaliados em três visitas após a alta da unidade de terapia intensiva. Incluíram-se 31 pacientes e, destes, 20 pacientes completaram o seguimento de 3 meses. Resultados: Ocorreu melhora significante dos seguintes aspectos: volume expiratório forçado em 1 segundo (L) (1,1/1,4/1,4; p = 0,019), Teste de Caminhada de 6 Minutos (m) (- /232,8/272,6; p = 0,04), escore BODE (7,5/5,0/3,8; p = 0,001), cognição avaliada com uso da escala Mini Mental State Examination (21/23,5/23,5; p = 0,008) e qualidade de vida avaliada pelo Saint George Respiratory Questionnaire (63,3/56,8/51; p = 0,02). A diferença média no escore total foi de 12,3 (entre as visitas um e três). Observaram-se diferenças clínicas importantes em relação ao escore de sintomas (18,8), escore de atividades (5,2) e escore de impacto (14,3). A maior parte dos participantes (80%) relatou que aceitaria uma nova admissão à unidade de terapia intensiva. Conclusão: Apesar da gravidade da doença, ao final do terceiro mês ocorreu uma significativa melhora clínica, funcional e de qualidade de vida. A maior parte dos pacientes aceitaria submeter-se a uma nova internação na unidade de terapia intensiva.

ABSTRACT Objective: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. Methods: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. Results: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. Conclusion: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.

Translation and cultural adaptation of a specific instrument for measuring asthma control and asthma status: the Asthma Control and Communication Instrument.

OBJECTIVE: To translate the Asthma Control and Communication Instrument (ACCI) to Portuguese and adapt it for use in Brazil. METHODS: The ACCI was translated to Portuguese and adapted for use in Brazil in accordance with internationally accepted guidelines. The protocol included the following steps: permission and rights of use granted by the original author; translation of the ACCI from English to Portuguese; reconciliation; back-translation; review and harmonization of the back-translation; approval from the original author; review of the Portuguese version of the ACCI by an expert panel; cognitive debriefing (the clarity, understandability, and acceptability of the translated version being tested in a sample of the target population); and reconciliation and preparation of the final version. RESULTS: During the cognitive debriefing process, 41 asthma patients meeting the inclusion criteria completed the ACCI and evaluated the clarity of the questions/statements. The clarity index for all ACCI items was > 0.9, meaning that all items were considered to be clear. CONCLUSIONS: The ACCI was successfully translated to Portuguese and culturally adapted for use in Brazil, the translated version maintaining the psychometric properties of the original version. The ACCI can be used in clinical practice because it is easy to understand and easily applied.

Leicester Cough Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil.

OBJECTIVE: To translate the Leicester Cough Questionnaire (LCQ) to Portuguese and adapt it for use in Brazil. METHODS: Cross-cultural adaptation of a quality of life questionnaire requires a translated version that is conceptually equivalent to the original version and culturally acceptable in the target country. The protocol used consisted of the translation of the LCQ to Portuguese by three Brazilian translators who were fluent in English and its back-translation to English by another translator who was a native speaker of English and fluent in Portuguese. The back-translated version was evaluated by one of the authors of the original questionnaire in order to verify its equivalence. Later in the process, a provisional Portuguese-language version was thoroughly reviewed by an expert committee. In 10 patients with chronic cough, cognitive debriefing was carried out in order to test the understandability, clarity, and acceptability of the translated questionnaire in the target population. On that basis, the final Portuguese-language version of the LCQ was produced and approved by the committee. RESULTS: Few items were questioned by the source author and revised by the committee of experts. During the cognitive debriefing phase, the Portuguese-language version of the LCQ proved to be well accepted and understood by all of the respondents, which demonstrates the robustness of the process of translation and cross-cultural adaptation. CONCLUSIONS: The final version of the LCQ adapted for use in Brazil was found to be easy to understand and easily applied.

Hospitalized patients with COPD: analysis of prior treatment.

OBJECTIVE: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. METHODS: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook). RESULTS: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. CONCLUSIONS: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.

Reliability of a rapid hematology stain for sputum cytology.

OBJECTIVE: To determine the reliability of a rapid hematology stain for the cytological analysis of induced sputum samples. METHODS: This was a cross-sectional study comparing the standard technique (May-Grünwald-Giemsa stain) with a rapid hematology stain (Diff-Quik). Of the 50 subjects included in the study, 21 had asthma, 19 had COPD, and 10 were healthy (controls). From the induced sputum samples collected, we prepared four slides: two were stained with May-Grünwald-Giemsa, and two were stained with Diff-Quik. The slides were read independently by two trained researchers blinded to the identification of the slides. The reliability for cell counting using the two techniques was evaluated by determining the intraclass correlation coefficients (ICCs) for intraobserver and interobserver agreement. Agreement in the identification of neutrophilic and eosinophilic sputum between the observers and between the stains was evaluated with kappa statistics. RESULTS: In our comparison of the two staining techniques, the ICCs indicated almost perfect interobserver agreement for neutrophil, eosinophil, and macrophage counts (ICC: 0.98-1.00), as well as substantial agreement for lymphocyte counts (ICC: 0.76-0.83). Intraobserver agreement was almost perfect for neutrophil, eosinophil, and macrophage counts (ICC: 0.96-0.99), whereas it was moderate to substantial for lymphocyte counts (ICC = 0.65 and 0.75 for the two observers, respectively). Interobserver agreement for the identification of eosinophilic and neutrophilic sputum using the two techniques ranged from substantial to almost perfect (kappa range: 0.91-1.00). CONCLUSIONS: The use of Diff-Quik can be considered a reliable alternative for the processing of sputum samples.

Hospitalized patients with COPD: analysis of prior treatment / Pacientes portadores de DPOC hospitalizados: análise do tratamento prévio

Objective: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. Methods: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook). Results: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. Conclusions: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater ...

Objetivo: Embora a DPOC seja uma enfermidade prevalente, ela é subtratada, e dados sobre o tratamento prévio são desconhecidos em nosso meio. Buscou-se verificar a adequação às recentes diretrizes no que se refere ao tratamento de manutenção em pacientes com DPOC antes de sua hospitalização e identificar possíveis variáveis associadas à inadequação do tratamento. Métodos: Estudo transversal, observacional e analítico, que incluiu 50 portadores de DPOC, internados em dois hospitais na cidade de Florianópolis (SC). Aplicou-se um questionário sobre parâmetros relacionados ao tratamento de manutenção da DPOC. Avaliou-se o manejo não farmacológico e a adequação do tratamento farmacológico à terapia preconizada pelo Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 e pelo Caderno de Atenção Básica (CAB) do Ministério da Saúde do Brasil sobre doenças respiratórias crônicas. Resultados: Na maioria dos pacientes, a DPOC foi classificada como grave ou muito grave. Em relação ao manejo não farmacológico, 33% eram tabagistas, apenas 32% foram orientados a receber vacinação anti-influenza, 28% receberam vacina anti-pneumocócica, e somente 6,5% dos pacientes nas categorias GOLD B, C e D realizaram reabilitação respiratória. O tratamento farmacológico foi inadequado em 50% e 74% da amostra, respectivamente, em relação às recomendações do GOLD e do CAB. Baseado nas recomendações do GOLD, 38% eram subtratados. Baixa escolaridade, baixa renda, não utilização de oxigenoterapia e ausência de vacinação anti-influenza associaram-se a inadequação do tratamento. Conclusões: Não foram seguidas satisfatoriamente várias ...