Original Article

Underdiagnosis of COPD at primary health care clinics in the city of Aparecida de Goiânia, Brazil

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Maria Conceição de Castro Antonelli Monteiro de Queiroz, Maria Auxiliadora Carmo Moreira, Marcelo Fouad Rabahi

J Bras Pneumol.2012;38(6):692-699

PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis

PLATINO, estudo de seguimento de nove anos sobre DPOC na cidade de São Paulo: o problema do subdiagnóstico

J Bras Pneumol.2014;40(1):30-37

Objective: To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated "Projeto Latino-Americano de Investigação em Obstrução Pulmonar" (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase. Methods: The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase. Results: The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD. Conclusions: The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention.

Keywords: Pulmonary disease, chronic obstructive/diagnosis; Pulmonary disease, chronic obstructive/epidemiology; Spirometry.

Brief Communication

Prevalence of HIV infection in tuberculosis patients treated at primary health care clinics in the city of Fortaleza, Brazil

Prevalência da infecção pelo HIV em pacientes com tuberculose na atenção básica em Fortaleza, Ceará

Helder Oliveira e Silva, Marcelo Luiz Carvalho Gonçalves

J Bras Pneumol.2012;38(3):382-385

Original Article

Sociodemographic and clinical characteristics of individuals exposed to smoking or biomass smoke and followed at primary health care centers in Brazil: a multicenter study

Juliana O Barros1, Flavio F Arbex2, Alcindo Cerci Neto3, Leandro G Fritscher4, Suzana E Tanni5, Gerson F Souza6, Oliver A Nascimento1,7, José R Jardim1

J Bras Pneumol.2025;51(3):e20250001

Objective: To describe the sociodemographic and clinical characteristics of individuals exposed to smoking or biomass smoke and followed at primary health care (PHC) centers across three states in Brazil. Methods: This was a cross-sectional multicenter study including patients followed at any of four PHC centers in Brazil. Patients = 35 years of age who were smokers or former smokers, or were exposed to biomass smoke were included, the exception being those with physical/mental disabilities and those who were pregnant. Face-to-face assessments included a questionnaire assessing clinical and sociodemographic characteristics, as well as the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale. Results: Of a total of 737 patients, 56.3% were female and 64.2% were White, with a mean age of 57.7 ± 11.8 years. Most (54.4%) had < 9 years of schooling, 50.2% had low socioeconomic status, and 71.5% were overweight/obese. Smokers accounted for 43.4% of the study sample, whereas 15.0% had no direct exposure to cigarette smoke. Common symptoms included cough, in 37.3%; wheezing, in 33.8%; and phlegm, in 27.4%. Most (75.1%) of the study participants had mMRC dyspnea scale scores of 0 or 1. CAT scores were 0-10, in 40.2%; 11-20, in 44.6%; 21-30, in 14.1%; and 31-40, in 1.1%. Binary logistic regression showed that sex and age significantly impacted mMRC dyspnea scale predictions, whereas BMI and socioeconomic status influenced CAT predictions. Common comorbidities included hypertension, in 51.3%; depression, in 27.4%; and diabetes, in 24.3%. No association was found between hypertension and obesity or smoking, or between diabetes and obesity or smoking. Conclusions: PHC patients with risk factors such as smoking and exposure to biomass smoke have a high comorbidity burden, with over half experiencing mild to moderate quality-of-life impacts. This study emphasizes the need for targeted preventive measures in PHC settings.

Keywords: Smoking; Risk factors; Biomass; Primary health care.

Letters to the Editor

Underdiagnosis of respiratory diseases during an economic downturn and the need forspirometry as a screening test

Subdiagnóstico de doenças respiratórias durante uma desaceleração econômica e necessidade do uso da espirometria como teste de triagem

Filio Kotrogianni, Foteini Malli, Konstantinos I Gourgoulianis

J Bras Pneumol.2013;39(2):254-255

Original Article

Food baskets given to tuberculosis patients at a primary health care clinic in the city of Duque de Caxias, Brazil: effect on treatment outcomes

Efeito do incentivo alimentício sobre o desfecho do tratamento de pacientes com tuberculose em uma unidade primária de saúde no município de Duque de Caxias, Rio de Janeiro

João Paulo Cantalice Filho

J Bras Pneumol.2009;35(10):992-997

Tuberculosis treatment: integration between hospitals and public health care clinics in the city of São Paulo, Brazil

Tratamento de tuberculose: integração entre assistência hospitalar e rede básica na cidade de São Paulo

Mirtes Cristina Telles Perrechi, Sandra Aparecida Ribeiro

J Bras Pneumol.2009;35(11):1100-1106

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD

Características clínicas, laboratoriais e funcionais da sobreposição asma-DPOC em pacientes previamente diagnosticados com DPOC

Ana Paula Adriano Queiroz1,2a, Fernanda Rodrigues Fonseca1,2a, Alexânia de Rê1,2a, Rosemeri Maurici1,2,5a

J Bras Pneumol.2021;47(1):e20200033

Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.

Keywords: Asthma/diagnosis; Pulmonary disease, chronic obstructive/diagnosis; Asthma-chronic obstructive pulmonary disease overlap syndrome/diagnosis.

Special Article

Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil

Questionário para avaliação de desempenho de serviços de atenção básica no controle da TB no Brasil

Tereza Cristina Scatena Villa, Antônio Ruffino-Netto

J Bras Pneumol.2009;35(6):610-612

Original Article

Estimated rates of recurrence, cure, and treatment abandonment in patients with pulmonary tuberculosis treated with a four‑drug fixed-dose combination regimen at a tertiary health care facility in the city of Rio de Janeiro, Brazil

Estimativas das taxas de recidiva, cura e abandono de tratamento em pacientes com tuberculose pulmonar tratados com esquema de dose fixa combinada de quatro drogas em uma unidade de saúde terciária na cidade do Rio de Janeiro

Vangie Dias da Silva1, Fernanda Carvalho de Queiroz Mello2, Sonia Catarina de Abreu Figueiredo2

J Bras Pneumol.2017;43(2):113-120

Epidemiological profile of tuberculosis cases reported among health care workers at the University Hospital in Vitoria, Brazil

Perfil epidemiológico dos casos notificados de tuberculose entre os profissionais de saúde no Hospital Universitário em Vitória (ES) Brasil

Thiago Nascimento do Prado, Heleticia Scabelo Galavote, Ana Paula Brioshi, Thamy Lacerda, Geisa Fregona, Valdério do Valle Detoni, Rita de Cássia Duarte Lima, Reynaldo Dietze, Ethel Leonor Noia Maciel

J Bras Pneumol.2008;34(8):607-613

Primary and acquired pyrazinamide resistance in patients with pulmonary tuberculosis treated at a referral hospital in the city of Recife, Brazil

Resistência primária e adquirida à pirazinamida em pacientes com tuberculose pulmonar atendidos em um hospital de referência no Recife

Liany Barros Ribeiro, Vera Magalhães, Marcelo Magalhães

J Bras Pneumol.2012;38(6):740-747

Acute asthma management in children: knowledge of the topic among health professionals at teaching hospitals in the city of Recife, Brazil

Manejo de crises asmáticas em crianças: conhecimento de profissionais de saúde quanto ao tópico em hospitais-escola do Recife (PE)*

Giovanna Menezes de Medeiros Lustosa, Murilo Carlos Amorim de Britto, Patrícia Gomes de Matos Bezerra

J Bras Pneumol.2011;37(5):584-588

Letters to the Editor

Analysis of the incidence of latent Mycobacterium tuberculosis infection among primary health care professionals in two Brazilian capitals

Análise da incidência da infecção latente por Mycobacterium tuberculosis entre profissionais de saúde da atenção básica em duas capitais do Brasil

Otávio Caliari Lima1,2, Fernanda Mattos de Souza2,3, Thiago Nascimento do Prado1,2, Romildo Luiz Monteiro Andrade4, Ethel Leonor Noia Maciel1,2

J Bras Pneumol.2020;46(2):e20190201

Bacteriological diagnosis of tuberculosis in prison inmates: actions taken by the primary health care teams in prisons

Diagnóstico bacteriológico de tuberculose na população privada de liberdade: ações desenvolvidas pelas equipes de atenção básica prisional

Karine Zennatti Ely1, Renata Maria Dotta2, Carla Adriane Jarczewski3, Andréia Rosane de Moura Valim1, Lia Gonçalves Possuelo1

J Bras Pneumol.2020;46(2):e20190179

Original Article

Frequency of COPD in health care workers who smoke

Frequência de DPOC em profissionais de saúde que fumam

Ivan Kopitovic1,2, Aleksandar Bokan1,2, Ilija Andrijevic1,2, Miroslav Ilic1,2, Sanja Marinkovic3, Dragana Milicic1,2, Marija Vukoja1,2

J Bras Pneumol.2017;43(5):351-356

Clinical treatment outcomes of tuberculosis treated with the basic regimen recommended by the Brazilian National Ministry of Health using fixed-dose combination tablets in the greater metropolitan area of Goiânia, Brazil

Desfechos clínicos do tratamento de tuberculose utilizando o esquema básico recomendado pelo Ministério da Saúde do Brasil com comprimidos em dose fixa combinada na região metropolitana de Goiânia

Anna Carolina Galvão Ferreira, José Laerte Rodrigues da Silva Júnior, Marcus Barreto Conde, Marcelo Fouad Rabahi

J Bras Pneumol.2013;39(1):76-83

Brief Communication

Performance comparison between the mycobacteria growth indicator tube system and Löwenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial

Comparação do desempenho do sistema mycobacteria growth indicator tube e meio Löwenstein-Jensen na detecção de rotina de Mycobacterium tuberculosis em unidades do sistema único de saúde no Rio de Janeiro: resultados preliminares de um ensaio clínico pragmático

Adriana da Silva Rezende Moreira, Gisele Huf, Maria Armanda Vieira, Leila Fonseca, Monica Ricks, Afrânio Lineu Kritski

J Bras Pneumol.2013;39(3):365-367

Original Article

Multidisciplinary education with a focus on COPD in primary health care

Perfil molecular do carcinoma pulmonar de células não pequenas no Nordeste brasileiro

Ana Claudia da Silva Mendes de Oliveira1,a, Antonio Vinicios Alves da Silva2,b, Marclesson Alves3,c, Eduardo Cronemberger3,d, Benedito Arruda Carneiro4,e, Juliana Carneiro Melo5,f, Francisco Martins Neto6,g, Fabio Tavora1,7,h

J Bras Pneumol.2019;45(3):e20180181

Objective: To investigate the histological subtypes and mutational profiles of non-small cell lung cancer in Brazil, looking for correlations among histological subtypes, expression of anaplastic lymphoma kinase (ALK), EGFR mutation status, and programmed death-ligand 1 (PD-L1) expression. Methods: We evaluated 173 specimens obtained from patients with lung adenocarcinoma in northeastern Brazil. Expression of PD-L1 and ALK was evaluated by immunohistochemistry; EGFR mutation status was evaluated by sequencing. We categorized the histological subtypes in accordance with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Results: The most common histological subtypes of lung adenocarcinoma were solid predominant (in 46.8%), acinar predominant (in 37.0%), and lepidic predominant (in 9.8%). ALK expression was detected in 10.4% of the samples, and 22.0% of the tumors harbored EGFR mutations. The most common EGFR mutation was an exon 21 L858R point mutation (in 45.5%), followed by an exon 19 deletion (in 36.3%). The tumor proportion score for PD-L1 expression was ≥ 50% in 18.2% of the samples, 1-49% in 32.7%, and 0% in 49.5%. The solid predominant subtype was significantly associated with wild-type EGFR status (p = 0.047). Positivity for PD-L1 expression was not found to be significantly associated with ALK expression or EGFR mutation status. Conclusions: Our results suggest that the molecular profile of non-small cell lung cancer in northeastern Brazil differs from those of populations in other regions of the country, with ALK positivity being higher than the other biomarkers. Further studies including clinical and genetic information are required to confirm these differences, as well as studies focusing on populations living in different areas of the country.

Keywords: Anaplastic lymphoma kinase; ErbB receptors; B7-H1 antigen; Carcinoma, non-small-cell lung; Brazil.

Multidisciplinary education with a focus on COPD in primary health care

Educação multiprofissional com foco na DPOC na atenção primária à saúde

Erikson Custódio Alcântara1,2,a, Krislainy de Sousa Corrêa2,3,b, José Roberto Jardim4,c, Marcelo Fouad Rabahi5,d

J Bras Pneumol.2019;45(6):e20180230

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