Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery / Função pulmonar e qualidade de vida em pacientes obesos mórbidos seis meses após cirurgia bariátrica

PURPOSE: To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. METHODS: Patients were evaluated before and six months after surgery. The patients were mainly female (75 percent), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05. RESULTS: The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre- and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF25-75 (Forced Expiratory Flow between 25 and 75 percent FVC) and FEV1/FVC percent (Forced Expiratory Volume in the 1st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables. CONCLUSIONS: There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation.

OBJETIVO: Investigar a evolução do peso corpóreo, da função pulmonar e da qualidade de vida de 20 pacientes obesos mórbidos seis meses após operação de Fobi-Capella. MÉTODOS: Os pacientes foram avaliados antes e seis meses após a cirurgia e o sexo feminino predominou em 75 por cento, com média de idade de 40,5 anos ± 10, 27, média de peso de 110,11 kg ± 21,77 e IMC de 39,93 kg/m² ± 7,13. Para a avaliação da função pulmonar foi realizada espirometria por meio do espirômetro Pulmonet Godart NV Bilt Vetr Holland, e para a qualidade de vida foi aplicado o questionário de Moorehead-Ardelt. As comparações entre os valores espirométricos do pré e do pós-operatório foram realizadas pelo teste t de Student para amostras pareadas, e para a correlação entre a perda de peso e função pulmonar utilizou-se análise de regressão linear simples, adotando-se p < 0,05 para todos os resultados. RESULTADOS: As variáveis espirométricas Freqüência Respiratória (FR), Volume de Reserva Expiratório (VRE) e Capacidade Residual Funcional (CRF) apresentaram, aos seis meses após a operação, diferença estatisticamente significativa com os valores pré-operatórios, porém, não houve diferença significativa de Volume Residual (VR), Capacidade Vital (CV), Capacidade Pulmonar Total (CPT), Fluxo Expiratório Médio entre 25 e 75 por cento da curva de CVF (FEF25-75 por cento) e Razão entre Volume Expiratório Forçado no 1º segundo e Capacidade Vital Forçada (VEF1/CVF por cento). Apenas uma paciente relatou piora da qualidade de vida após a operação. Houve correlação positiva entre a perda da porcentagem do excesso de peso e VRE (p=0,0117, r=0,5514); as demais variáveis não apresentaram correlação significativa. CONCLUSÕES: Houve perda significante de peso, melhora da função pulmonar evidenciada pela redução da freqüência respiratória, aumento do volume de reserva expiratório e da capacidade residual funcional. A qualidade de vida dos pacientes melhorou nos seis meses após a operação de Fobi-Capella.

Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery.

PURPOSE: To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. METHODS: Patients were evaluated before and six months after surgery. The patients were mainly female (75%), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05. RESULTS: The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre- and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF25-75 (Forced Expiratory Flow between 25 and 75% FVC) and FEV1/FVC% (Forced Expiratory Volume in the 1st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables. CONCLUSIONS: There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation.

Effects of acute magnesium loading on pulmonary function of stable COPD patients.

BACKGROUND: Magnesium (Mg) use has the potential to promote bronchodilatation and to improve lung function in obstructive diseases. IV administration of Mg during exacerbations of chronic obstructive pulmonary disease (COPD) has led to improved peak flow. This study aimed to investigate the effects of acute IV Mg loading on respiratory parameters of stable COPD patients. MATERIAL/METHODS: This was a randomized, double-blind, placebo-controlled crossover study. Twenty-two male COPD patients (64+/-6 years old, FEV1: 49+/-20%) received an IV infusion of 2 g of magnesium sulfate or placebo on two distinct occasions. Spirometry and mouth maximal respiratory pressures were obtained before and 45 minutes after the infusions. RESULTS: Mg use led to significant changes in functional respiratory capacity (-0.48 l, 95%CI: -0.96, -0.01), inspiratory capacity (0.21 l, 95%CI: 0.04, 0.37), maximal inspiratory pressure (10 cmH2O, 95%CI: 1.6, 18.4), and maximal expiratory capacity (10.7 cmH2O, 95%CI: 0.20, 21.2). The treatment was also associated with a marginally significant decrease in residual volume (-0.47 L, 95%CI: -0.96, 0.02, p=0.06). CONCLUSIONS: Acute IV Mg loading in stable COPD patients was associated with a reduction in lung hyperinflation and improvement of respiratory muscle strength. The clinical potential for chronic magnesium supplementation in COPD deserves further investigation.

Inflammatory and functional effects of increasing asthma treatment with formoterol or double dose budesonide.

Adding a long-acting beta(2)-agonist to inhaled corticosteroids (ICS) for asthma treatment is better than increasing ICS dose in improving clinical status, although there is no consensus about the impact of this regimen on inflammation. In this double-blind, randomized, parallel group study, asthmatics with moderate to severe disease used budesonide (400 mcg/day) for 5 weeks (run-in period); then they were randomized to use budesonide (800 mcg/day--BUD group) or budesonide plus formoterol (400 mcg and 24 mcg/day, respectively--FORMO group) for 9 weeks (treatment period). Home PEF measurements, symptom daily reporting, spirometry, sputum induction (for differential cell counts and sputum cell cultures), and hypertonic saline bronchial challenge test were performed before and after treatments. TNF-alpha, IL-4 and eotaxin-2 levels in the sputum and cell culture supernatants were determined. Morning and night PEF values increased in the FORMO group during the treatment period (p<0.01), from 435+/-162 to 489+/-169 and 428+/-160 to 496+/-173 L/min, respectively. The rate of exacerbations in the FORMO group was lower than in the BUD group (p<0.05). Neutrophil counts in sputum increased in both groups (p<0.05) and leukocyte viability after 48 h-culture increased in the FORMO group (p<0.05). No other parameter changed significantly in either group. This study showed that adding formoterol to budesonide improved home PEF and provided protection from exacerbations, although increase of leukocyte viability in cell culture may be a matter of concern and needs further investigation.

Bronchial responsiveness during esophageal acid infusion.

Among the possible mechanisms explaining the worsening of asthma due to gastroesophageal reflux disease (GERD) is the increase in bronchial hyperresponsiveness. The effects of GERD on bronchial hyperresponsiveness in patients with bronchial asthma have yet to be studied in significant detail. The aim of this study was to determine the effects of esophageal acid perfusion on bronchial responsiveness to bradykinin in patients with both asthma and GERD. In 20 patients with asthma and GERD disease, esophageal pH was monitored with a pH meter and bronchial responsiveness was evaluated by aerosol inhalation of bradykinin during esophageal acid perfusion and, 24 h earlier or later the patients were submitted to another bronchial provocation test without acid infusion. No significant changes were observed in FEV(1), FEF(25-75%), FVC, or PEF during acid perfusion. The response to the bronchial provocation test did not differ between the control day and the day of acid infusion (p = 0.61). The concentration provoking a 20% fall in FEV(1) (geometric mean +/- geometric SD) was 1.09 +/- 5.84 on the day of acid infusion and 0.98 +/- 5.52 on the control day. There is no evidence that acid infusion changes bronchial responsiveness to bradykinin. These findings strongly question the significance of acid infusion as a model to study the pathogenesis of GERD-induced asthma.

Investigação de fatores associados à asma de difícil controle / Investigation of factors associated with difficult-to-control asthma

OBJETIVO: Pesquisar a freqüência dos fatores associados à asma de difícil controle. MÉTODOS: Foram selecionados pacientes com diagnóstico de asma grave do ambulatório de asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os pacientes foram classificados em dois grupos: asma grave controlada e asma grave de difícil controle. Após nova tentativa de otimização do tratamento para o grupo de difícil controle, foram aplicados questionário e investigação complementar de fatores associados, como exposição ambiental domiciliar e ocupacional, tabagismo, fatores sociais, rinossinusite, doença do refluxo gastroesofágico (DRGE), apnéia obstrutiva do sono, insuficiência cardíaca congestiva (ICC), embolia pulmonar, fibrose cística, disfunção de cordas vocais, deficiência de alfa-1 antitripsina e vasculite de Churg-Strauss. RESULTADOS: Foram selecionados 77 pacientes com asma grave, dos quais 47 apresentavam asma de difícil controle, sendo 68,1 por cento do sexo feminino, idade média de 44,4 anos (±14,4) e volume expiratório forçado no primeiro segundo de 54,7 por cento (±18,3 por cento). Dos diagnósticos encontrados em associação à asma de difícil controle, o mais freqüente foi a pouca adesão ao tratamento (68 por cento). Outros foram as más condições ambientais (34 por cento) e ocupacionais (17 por cento), rinossinusite (57 por cento), DRGE (49 por cento), apnéia obstrutiva do sono (2 por cento), ICC (2 por cento) e tabagismo (10 por cento). Em todos os casos, pelo menos um desses fatores concomitantes foi diagnosticado. CONCLUSÕES: O fator mais freqüente associado à asma de difícil controle nos indivíduos estudados é a pouca adesão à medicação prescrita. A investigação de co-morbidades é imperativa na avaliação de pacientes com esta forma da doença.

OBJECTIVE: To determine the prevalence of factors associated with difficult-to-control asthma. METHODS: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. RESULTS: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1 percent female, with mean age of 44.4 years (±14.4), and forced expiratory volume in one second of 54.7 percent (±18.3). The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68 percent), rhinitis/sinusitis (57 percent), GERD (49 percent), environmental exposure (34 percent), occupational exposure (17 percent), smoking history (10 percent), obstructive sleep apnea (2 percent), and CHF (2 percent). At least one of these factors was identified in every case. CONCLUSIONS: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.

Correlations of Egen Klassifikation and Barthel Index scores with pulmonary function parameters in Duchenne muscular dystrophy.

PURPOSE: This study investigated the correlations obtained by using the Egen Klassifikation (EK) and Barthel Index (BI) functional scales and respiratory function parameters in patients with Duchenne muscular dystrophy. METHODS: Spirometry, maximal respiratory pressures, and arterial blood gases were analyzed and graded according to the EK and BI scales in 26 patients. They were classified as high or low risk for introduction of noninvasive ventilation according to the respiratory function. RESULTS: The EK and BI scales significantly correlated with forced vital capacity, forced expiratory volume in 1 second, and maximal respiratory pressures. The worse the functional performance, the worse the respiratory measurements. The degree of correlation between the functional scales and each respiratory parameter was similar. An EK of 21 or higher predicted high risk for the introduction of noninvasive ventilation. CONCLUSIONS: EK and BI scales similarly correlated with the degree of respiratory involvement in Duchenne muscular dystrophy. The EK scale was superior in detecting subjects with a higher risk for introduction of noninvasive ventilation.

Lung function and airway hyperresponsiveness in adult patients with sickle cell disease.

BACKGROUND: Lung disease is a major cause of morbidity and death in sickle cell disease. Although airway hyperresponsiveness has been noted in children, there are no studies in adult sickle cell patients. The aim of this study was to investigate the prevalence of airway hyperresponsiveness in adult sickle cell patients. METHODS: Twenty-six patients with sickle cell disease (10 HbSC, 9 HbSS, and 7 HbSbeta) were compared with 28 normal control subjects. Pulmonary function tests, including spirometry, measurements of single-breath diffusing capacity and the methacholine challenge test were performed. RESULTS: There were no significant differences in age, gender, or height between groups. Restrictive ventilatory defect was observed in six patients (24%) in the sickle cell disease group. Obstructive ventilatory defect and reduced diffusing lung DLCO capacity was observed in all sickle cell disease subgroups. A positive methacholine challenge test was obtained in eight (31%) sickle cell patients and in two of the 28 controls (7%). CONCLUSION: These features suggest that there is a high prevalence of airway hyperresponsiveness in adult patients with sickle cell disease without a history of reactive airway disease.

Avaliação de um programa de treinamento físico por quatro meses para crianças asmáticas / Evaluation of a four-month program of physical training designed for asthmatic children

OBJETIVO: Avaliar condicionamento físico e força muscular de crianças asmáticas antes e depois de quatro meses de participação num programa de exercícios físicos. MÉTODOS: Dois grupos de crianças com asma moderada e idade entre oito e onze anos foram formados. Ambos realizaram testes pré e pós-treinamento físico, duas vezes por semana, por quatro meses, em sessões de 90 minutos, com exercícios em solo e em água. Orientações sobre asma, seu controle e tratamento foram fornecidos a ambos os grupos. RESULTADOS: Na avaliação final, observou-se aumento das variáveis antropométricas em ambos os grupos. O grupo exercício apresentou melhora significativa na distância percorrida em nove minutos (inicial 1,333 + 0,03 km e final 1,440 + 0,03 km; p < 0,05), número de flexões abdominais (inicial 24,3 + 1,4 abdominais e final 33,2 + 1,1 abdominais; p < 0,05), pressão inspiratória máxima (inicial 73 + 5 cmH2O e final 103 + 5 cmH2O; p < 0,05), pressão expiratória máxima (inicial 75 + 4 cmH2O e final 102 + 4 cmH2O; p < 0,05) e na freqüência cardíaca de repouso (inicial 84,3 + 1,6 bpm e final 77,1 + 2,7 bpm; p < 0,05). O grupo controle não mostrou variação significativa em nenhum desses parâmetros. CONCLUSÃO: Um programa de treinamento físico com menor freqüência e maior duração de cada sessão, para facilitar a participação das crianças, propicia melhora do condicionamento físico e aumento de força muscular em crianças asmáticas.

Efeito da acidificação esofágica na obstrução brônquica de pacientes asmáticos com refluxo gastroesofágico / The effect of esophageal acidification on bronchial obstruction in asthmatics with gastroesophageal reflux

INTRODUÇAO: A relação entre asma e refluxo gastroesofágico permanece pouco compreendida. O reflexo vagal e a microaspiração estão entre os mecanismos propostos para explicar a piora da asma pelo refluxo gastroesofágico. OBJETIVO: Avaliar o volume expirado forçado no primeiro segundo após a acidificação esofágica. MÉTODO: O estudo investigou os efeitos da infusão ácida em treze voluntários portadores de asma moderada e refluxo gastroesofágico. Foram realizadas espirometrias antes e depois da inserção esofágica de uma sonda nasogástrica 8F e um cateter de pHmetria. Outras medidas de volume expirado forçado no primeiro segundo foram realizadas depois de quinze minutos de infusão de solução salina no ponto médio entre o esfíncter esofágico superior e o inferior, e depois de quinze minutos da acidificação esofágica, a cada cinco minutos mantida a acidificação, até a obtenção de um valor estável (variação < 5 por cento). RESULTADOS: O volume expirado forçado no primeiro segundo (média do grupo) apresentou-se estável durante os procedimentos de sondagem, infusão de solução salina, infusão de ácido clorídrico e manutenção de ácido clorídrico (p = 0,72). Dois casos apresentaram queda do volume expirado forçado no primeiro segundo (de 11 por cento e 22 por cento) devida à sondagem, outros dois pela infusão de solução salina (13 por cento e 14 por cento) e um caso após a infusão ácida (de 22 por cento). CONCLUSAO: A acidificação esofágica por pequenos períodos não desencadeia alterações espirométricas num grupo de asmáticos com refluxo gastroesofágico. Entretanto, há casos em que a simples manipulação esofágica ou infusões causam broncoespasmo.

Dispnéia / Dyspnea

Dispnéia é o termo usado para designar a sensação de dificuldade respiratória, experimentada por pacientes acometidos por diversas moléstias, e indivíduos sadios, em condições de exercício extremo. Ela é um sintoma muito comum na prática médica, sendo particularmente referida por indivíduos com moléstias dos aparelhos respiratório e cardiovascular. Esse sintoma é o principal fator limitante da qualidade de vida relacionada à saúde de pacientes pneumopatas crônicos. Apesar de sua importância, os mecanismos envolvidos com seu surgimento ainda não são completamente conhecidos. Neste artigo, os autores fazem uma pequena revisão de aspectos clínicos e fisiopatológicos desse sintoma

Clonidine as a pre-anesthetic agent for flexible bronchoscopy.

Several drugs have been employed for sedation during flexible fiberoptic bronchoscopy (FOB). Clonidine attenuates stress-induced sympathoadrenal responses and has sedative properties. We investigate the effects of clonidine premedication on hemodynamic and comfort parameters of patients submitted to FOB under airway topical anesthesia only. Patients received placebo (n = 22; men = 16; median age = 50.5 years) or intravenous clonidine (3 microg/kg; n = 20; men = 15; median age = 46.0 years) 15 min before FOB. Blood pressure (BP), heart rate (HR), plasma norepinephrine (nor) and cortisol levels were measured before, during, and 1 h after FOB. Comfort was assessed by the examiner and by the patients using a visual numerical scale (0-10). The placebo group showed significant increases in systolic BP, HR, and nor levels during FOB (SBP = 125 mmHg x 145 mmHg; HR = 74 bpm x 85 bpm; nor = 316.2 pg/dl x 483.1 pg/dl), whereas clonidine group did not display such changes. Clonidine group showed a lower frequency of cardiac arrhythmias than the placebo group during and after FOB (supraventricular = 39% x 50%; ventricular = 22% x 40%). Levels of comfort were high and comparable in both groups. We concluded that although clonidine led to a somewhat better hemodynamic profile, it did not contribute to better comfort in this setting.

Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome.

OBJECTIVES: To determine the frequency and the clinical characteristics of hepatopulmonary syndrome (HPS) in cirrhotic candidates for orthotopic liver transplantation and to identify the major respiratory parameters predictive of the presence of changes in arterial oxygenation. PATIENTS AND METHODS: Patients underwent transthoracic contrast-enhanced echocardiography, pulmonary scintigraphy, pulmonary function test with diffusing capacity of lung for carbon monoxide (DLCO), and measurement of arterial blood gases. RESULTS: Fifty-six patients were studied. Twenty-five patients (45%) presented with intrapulmonary vascular dilatations, but only 9 (16%) fulfilled the criteria for HPS. The clinical or demographic characteristics considered did not differ in the patients with and without HPS. The DLCO value was significantly lower in patients with HPS (P=.01). However, 32 (80%) of 40 patients with low DLCO values did not fulfill the criteria for HPS. An alveolar arterial oxygen gradient (AaPO2) of more than 20 mm Hg showed a higher diagnostic accuracy (91%) in the assessment of HPS than did the DLCO of less than 80% predicted (41%) and the AaPO2 of more than 15 mm Hg (71%). CONCLUSIONS: The AaPO2 proved to be a more reliable index than PaO2 and DLCO for the determination of changes in arterial oxygenation in HPS. The DLCO does not seem to be a good marker for HPS screening. Intrapulmonary vascular dilatations were frequent, even in patients who did not fulfill the criteria for HPS.

Sputum induction: review of literature and proposal for a protocol.

Since the 1980s, sputum induction by inhalation of hypertonic saline has been successfully used for diagnosing Pneumocystis carinii pneumonia in patients infected with HIV. In recent years, sputum induction and its subsequent processing has been refined as a noninvasive research tool providing important information about inflammatory events in the lower airways, and it has been used for studying various illnesses. In asthma, one application is to use sputum inflammatory indices to increase our understanding of complex relationships between inflammatory cells, mediators, and cytokine mechanisms. In chronic obstructive pulmonary disease, sputum assessment could be used as a screening test before deciding on long-term corticosteroid treatment. In tuberculosis, sputum induction is a valuable diagnostic tool for HIV-seropositive patients who do not produce sputum. Sputum induction appears to be a relatively safe, noninvasive means of obtaining airway secretions from subjects with cystic fibrosis, especially from those who do not normally produce sputum. Moreover, sputum induction can also be used in chronic cough and lung cancer. Generally, induction is performed through ultrasonic nebulizers, using hypertonic saline. It is recommended that sputum be processed as soon as possible, with complete homogenization by the use of dithiothreitol. We have also shown in this article an example of a protocol for inducing and processing sputum employing a nebulizer produced in Brazil.

Tromboembolismo pulmonar: diagnóstico e tratamento / Pulmonary thromboembolism: diagnosis and theraty

O tromboembolismo pulmonar é uma doença freqüente, porém pouco diagnosticada, fato justificado, em primeiro lugar, por ser doença que apresenta sinais e sintomas pouco específicos, causando demora na suspeita clinica, além disso, apesar de haver vários exames complementares, que podem auxiliar no seu diagnóstico, muitos não estão disponíveis na maioria dos serviços médicos. A demora, no diagnóstico, tem repercussões muito sérias, culminando no aumento da mortalidade de pessoas com tromboembolismo pulmonar. Dessa forma, é fundamental empenhar todo esforço no diagnóstico e no tratamento precoce dessa doença. Assim, esta revisão tem como objetivos principais estimular a suspeita diagnóstica e orientar a investigação e o tratamento da referida doença

Abordagem terapêutica na exacerbação da doença pulmonar obstrutiva crônica (DPOC) / Management in exacerbations of chronic obstructive pulmonary disease (COPD)

Exacerbações de DPOC causam aumento da morbimortalidade, internação, piora da qualidade de vida e custos para o paciente e para o sistema de saúde. O paciente com DPOC apresenta, aproximadamente, duas a três exacerbações ao ano, principalmente no inverno, causando progressiva deterioração fisiológica e aumento da inflamação das vias aéreas. O tratamento se faz com broncodilatadores, corticosteróides, oxigenoterapia, ventilação mecânica e antibióticos, em alguns casos

Sputum induction: review of literature and proposal for a protocol

Since the 1980s, sputum induction by inhalation of hypertonic saline has been successfully used for diagnosing Pneumocystis carinii pneumonia in patients infected with HIV. In recent years, sputum induction and its subsequent processing has been refined as a noninvasive research tool providing important information about inflammatory events in the lower airways, and it has been used for studying various illnesses. In asthma, one application is to use sputum inflammatory indices to increase our understanding of complex relationships between inflammatory cells, mediators, and cytokine mechanisms. In chronic obstructive pulmonary disease, sputum assessment could be used as a screening test before deciding on long-term corticosteroid treatment. In tuberculosis, sputum induction is a valuable diagnostic tool for HIV-seropositive patients who do not produce sputum. Sputum induction appears to be a relatively safe, noninvasive means of obtaining airway secretions from subjectswith cystic fibrosis, especially from those who do not normally produce sputum. Moreover, sputum induction can also be used in chronic cough and lung cancer. Generally, induction is performed through ultrasonic nebulizers, using hypertonic saline. It is recommended that sputum be processed as soon as possible, with complete homogenization by the use of dithiothreitol. We have also shown in this article an example of a protocol for inducing and processing sputum employing a nebulizer produced in Brazil

Effects of ondansetron on respiratory pattern and sensation of experimentally induced dyspnea.

CONTEXT: Dyspnea remains a therapeutic challenge, especially in chronic respiratory conditions. Recent studies have shown that the induction of unpleasant dyspnea sensations activates areas in the insular cortex. OBJECTIVE: This study was designed to investigate the potential effects of ondansetron, a potent anti-serotonin agent, on induced dyspnea sensation. TYPE OF STUDY: A randomized double blind study. SETTING: Pulmonary Function Laboratory of Hospital das Clínicas de Ribeirão Preto. PARTICIPANTS: Ten healthy male volunteers (mean age +/- standard error = 23.1 +/- 0.41 years) without respiratory diseases and showing normal spirometric tests. INTERVENTIONS: Uncomfortable breathing was induced in the volunteers on two different days, via the use of inspiratory resistors (loads of 0, 7, 14 and 21 cm H2O/l/sec) and breathholding, two hours after taking 8 mg of ondansetron (Ond) or placebo (Plac). MAIN MEASUREMENTS: Respiratory discomfort during breathing under loading was evaluated on a 100-mm visual analog scale. The maximum length of time of voluntary apnea was measured in seconds. RESULTS: The mean maximum voluntary apnea time did not differ between the ondansetron and placebo days (Plac = 96 +/- 6.6 sec vs. Ond = 100 +/- 7.9 sec). Ondansetron did not influence the dyspnea sensation induced by different inspiratory loads (0 cm H2O/l/sec: Ond = 1.4 mm +/- 0.44 vs. Plac = 2.1 +/- 0.85 mm; 7 cm H2O/l/sec: Ond = 16.6 +/- 2.74 mm vs. Plac = 13.7 +/- 2.06 mm; 14 cm H2O/l/sec; Ond = 30.5 +/- 4.50 mm vs. Plac = 27.1 +/- 3.44 mm; 21 cm H2O/l/sec: Ond = 50.3 +/- 6.72 mm vs. Plac = 49.4 +/- 6.72 mm). Ondansetron led to significant decreases in tidal volume under basal conditions and when breathing under the highest inspiratory loading (0 cm H2O/l/sec: Ond = 0.83 +/- 0.26 l vs. Plac = 1.0 +/- 0.28 l; 21 cm H2O/l/sec: Ond = 0.86 +/- 0.23 l vs. Plac = 1.1 +/- 0.22 l) CONCLUSION: The present results suggest that 5-HT3 receptors do not play an important role in the mediation of dyspnea sensations.

Morning-to-evening variation in exercise-induced bronchospasm.

BACKGROUND: Exercise is one of the most common triggers of asthmatic symptoms. Many factors, including hyperventilation, determine the prevalence and severity of exercise-induced bronchospasm (EIB). However, the influence of time of day has not been adequately described. OBJECTIVE: We sought to compare morning and evening EIB and minute ventilation during exercise (VE). METHODS: Twenty-two patients with stable asthma and 12 control subjects underwent exercise challenge at 7 am and 6 pm. The time of the first challenge was randomly assigned; the second challenge was performed within 1 week of the first. The primary outcomes were EIB intensity (maximum fall in FEV(1)) and VE. RESULTS: The asthma group exhibited lower EIB values in the morning: 14.8% +/- 3.7% at 7 am vs 21.4% +/- 4.2% at 6 pm (P =.004)-ie, 0.37 +/- 0.09 L vs 0.53 +/- 0.10 L, respectively (P =.002). VE was higher at 7 am (55.4 +/- 4.7 L/min) than at 6 pm (52.4 +/- 4.3 L/min; P =.03). Baseline FEV(1) increased from 2.33 +/- 0.13 L (morning) to 2.49 +/- 0.15 L (evening; P =.04), and a significant correlation between baseline FEV(1) and EIB was found in the evening (r = +0.5; P =.049) but not in the morning. Post-exercise FEV(1) was similar at 7 am (1.96 +/- 0.13 L) and 6 pm (1.97 +/- 0.14 L). For the control group, no changes were detected in FEV(1) fall or VE. CONCLUSION: Baseline airway caliber contributes to the mechanisms of the morning-to-evening EIB enhancement.