Objective: The impact of chronic obstructive pulmonary disease (COPD) is underestimation as a result of underdiagnosis and undertreatment. The objective of this study was to determine whether using spirometry to evaluate smokers enrolled in smoking cessation programs facilitates early diagnosis of COPD. Methods: The medical records of 158 smokers enrolled in the smoking cessation program at the Botucatu School of Medicine (Botucatu, Brazil) between January of 2003 and November of 2005 were evaluated retrospectively. All were over 40 years old (mean age: 55 ± 8.5 years), and 99 (62.6%) were female. We analyzed the clinical data, the previous medical diagnosis, and the spirometry results. Results: The diagnostic criteria for COPD were met by 57 (36.1%) of the 158 individuals evaluated, and 14 individuals (8.9%) were considered to be at risk for the development of the disease. Of those 57 individuals meeting the criteria for a diagnosis of COPD, 39 (68.4%) were receiving their first diagnosis of COPD, whereas 18 (31.6%) were receiving confirmation of a prior diagnosis. Of the 18 individuals previously diagnosed, 10 (56%) presented the mild/moderate form of the disease, and 8 (44%) presented the severe form. Of the 39 newly diagnosed individuals, 38 (97,4%) presented the mild/moderate for of the disease, and only 1 (2,6%) had severe COPD. Seven patients previously diagnosed with COPD presented pulmonary function test results inconsistent with the diagnostic criteria. Conclusion: Using spirometry in the initial evaluation of smokers enrolling in smoking cessation program might be a useful tool for early diagnosis of COPD.

Keywords: Smoking cessation; Spirometry; Pulmonary disease, chronic obstructive.

Objective: To define the profile of smokers who seek professional assistance through a smoking cessation program and to compare smoker profiles among males, females and elderly people. Methods: Two-hundred and three smokers were prospectively evaluated. The participants completed questionnaires related to smoking history, history of psychiatric disorders, depression, anxiety and nicotine dependence as well as a general self-report questionnaire. Results: In this sample, 58.6% of the individuals were female (119). The mean age was 45.3 ± 12.0 years, with no statistically significant difference between genders (p = 0.391). The majority of the individuals in the sample (84.2%) presented socioeconomic class C or above. Sixty-three percent had at least a high school education. Depression was more often referred to by women, and the difference between genders was borderline significant (p = 0.069). However, when depression was evaluated using the Beck Depression Inventory, there was no statistically significant difference between genders and between elderly and nonelderly people. Conclusions: In the profile of the smokers who sought assistance, we identified aspects (such as being female and having been diagnosed with depression) that are known predictors of treatment failure. This shows the importance of carrying out a complete pre-evaluation of the profile of a smoker who seeks a smoking cessation program. Thus, procedures can be adopted prior to and during the treatment of the smoker, with the objective of increasing treatment success rates.

Keywords: Anxiety; Depression; Smoking.

Introduction: The patient with COPD has his global physical activity decreased due to a progressive worsening of the lung function resultant from any kind of physical effort he may perform. Pulmonary rehabilitation (PR) is used in the United States and Europe as an alternative therapy in COPD treatment. Objective: To evaluate the effectiveness of PR as an ancillary treatment for COPD. Patients and methods: 30 patients prospectively submitted to the PR program developed in six weeks with three weekly sessions. Evaluation included clinical history and complete physical examination, the six-minute walking distance test, maximum workload test for upper limbs, maximum load test for lower limbs, a questionnaire of effort perception, spirometry and analysis of blood gases. Results: Concerning spirometry and analysis of blood gases, pre and post PR program, no statistically significant change was observed (p > 0.05). Pre and post PR program, statistically significant values (p < 0.05) were observed in the decrease in effort perception and increase in functional physical capacity, maximum workload test for upper limbs and incremental test for lower limbs used to determine the maximum workload. Conclusions: The authors concluded that, in the group studied, the PR program increased the patients' physical capacity and maximum workload for upper limbs whereas no changes were observed in the data regarding spirometry and analysis of blood gases.

Keywords: Rehabilitation. Therapeutical approaches. Lung diseases obstructive. Treatment outcome. Exercise therapy.

Objective: To assess the effect of psychotherapy on levels of anxiety and depression, as well as on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program. Methods: A randomized, controlled, blind clinical trial was conducted involving 49 chronic obstructive pulmonary disease patients. Patients were randomized into three groups: those submitted to the complete pulmonary rehabilitation program, which included psychotherapy and an exercise regimen (group 1); those submitted to the program minus physical exercise (group 2); and those submitted to the program minus psychotherapy (group 3). The three groups underwent a 12-week treatment program. All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program through four instruments: The Beck Anxiety Inventory, Beck Depression Inventory and St. George's Respiratory Questionnaire were applied. The distance walked-weight product was also calculated. Results: Statistically significant absolute improvements in exercise capacity were found for groups 1 and 2, although not for group 3 (p = 0.007, p = 0.008 and p = 0.06, respectively). In groups 1 and 2, levels of anxiety and depressions were also significantly reduced (group 1: p = 0.0000 and p < 0.0003; group 2: p = 0.0001 and p = 0.0014), and quality of life was significantly improved (p = 0.0007 and p = 0.002, respectively). Anxiety levels were also reduced in group 3 (p = 0.03), although levels of depression were not, and quality of life was unaffected. Conclusion: Psychotherapy sessions provided as part of a pulmonary rehabilitation program assist patients with chronic obstructive pulmonary disease in coping with disease-related limitations by reducing behavioral symptoms, especially depression, thereby influencing exercise capacity and health-related quality of life.

Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Pullmonary diseases, chronic obstructive/psychology; Anxiety; Depression; Quality of Life; Exercise therapy

Background: Chronic obstructive pulmonary disease is detrimental to lung mechanics and peripheral muscles. The physical programs developed for this condition are usually targeted to an improvement on aerobics capacity. Programs that approach specifically the changes in thoracic mobility and thoracic muscles are rare. Objective: To assess the effects of a physical exercise program designed to increase chest wall mobility on functional and psychosocial capacity in moderate to severe chronic obstructive pulmonary disease patients. Methods: Thirty patients with moderate to severe chronic obstructive pulmonary disease were studied. They were randomized to 2 groups: control group (CG) and treated group (TG). The CG was submitted to an educational program and the TG was submitted to an educational program plus a physical exercise program aiming to increase chest wall mobility. Variables included spirometry, thoracic mobility, quality of life, anxiety and depression levels and a six minute walk test (6MWT). Results: After 2 months of training, only the TG presented improvements on chest wall mobility (from 4.20 ± 0.58 cm to 5.27 ± 0.58 cm; p = 0.05) and 6MWT (from 469.73 ± 31.99 m to 500.60 ± 27.38 m; p = 0.01). It was also observed that the TG presented improvement on the St. George's Respiratory Questionnaire (SGRQ) score, Chronic Respiratory Questionnaire (CRQ), and Beck's depression scale after 2 months of treatment. Pulmonary function did not improve either in the CG or in the TG group. Conclusion: Our results suggest that exercises aimed to the increasing of chest wall mobility improve thoracic mobility, quality of life, submaximal exercise capacity, and reduce dyspnea and depression symptoms in chronic obstructive pulmonary disease patients.

Keywords: COPD. Thoracic mobility. Quality of life. Capacity of exercise. Dyspnea.

Objective: To evaluate the limited participation by university students in a smoking cessation program. Methods: A cross-sectional, comparative study was conducted at the University of Caxias do Sul, located in Caxias do Sul, Brazil, involving students who enrolled in a smoking cessation program, together with those who did not. Results: Of the 108 student who did not enroll in the program, 102 (94.4%) stated that they had no intention to quit smoking (95% confidence interval: 88.29-97.93%. Comparisons between the enrolled and nonenrolled students revealed the following statistical differences: in mean age (35 vs. 23 years, p < 0.01); mean duration of the smoking habit (19.42 vs. 7.36 years, p < 0.01); considering oneself addicted (100% vs. 58.5%, p = 0.047); believing oneself able to stop smoking at any time (7.1% vs. 22.6%, p = 0.02); having no knowledge of any reasons to quit smoking (37.5% vs. 12%, p = 0.03); having suffered discrimination (42.9% vs. 9.3%, p < 0.01). Conclusion: Among the university students evaluated, there was a phase, classified as precontemplative or contemplative, during which they were refractory to smoking cessation. Although all of the students were aware of the diseases caused by smoking, 41.5% did not consider themselves addicted. The concept of substance dependence does not apply to these students. It would seem more appropriate to define nicotine dependence as resulting from the lifetime consumption of at least 100 cigarettes. These students do not perceive that they are passing through the initial phase of the natural history of tobacco use disorder and do not realize that they are increasing their risk of presenting smoking-related diseases in the future.

Keywords: Smoking; Students; Smoking cessation

Background: Pulmonary Rehabilitation (PR) improves the quality of life of chronic obstructive pulmonary disease (COPD) patients. However, the influence of PR on the sleep pattern of these patients is unknown. Objective: To evaluate the influence of PR on the sleep patterns of patients with COPD. Method: A total of 27 patients (22 men/5 women) were submitted to polysomnographic, gasometric and anthropometric studies before and after six weeks of PR and were evaluated using the Epworth Sleepiness Scale. The results were analyzed using paired Student's t-test, ANOVA and Newman-Keuls multiple comparison test. Results: Mean age was 63.3 5.3 years, mean FEV1 was 54.8 25.4% of predicted, mean FEV1/FVC was 49.9 12.0% of predicted, mean resting PaO2 was 69.7 7.3 mmHg, and mean resting SaO2 was 93.7 2.1%. Polysomnography revealed sleep patterns to be fragmented, with frequent waking and reduced slow-wave sleep, as well as oxygen desaturation. The most significant drops in oxygen saturation occurred during rapid eye movement sleep. No significant differences were observed between pre- and post-PR values for the other variables studied (p > 0.05).Conclusion: In the group of patients studied, PR did not alter sleep patterns.

Keywords: Sleep. Pulmonary Disease. Chronic Obstructive. Lung Diseases, rehabilitation.

Pulmonary thromboembolism and exacerbation of chronic obstructive pulmonary disease are common conditions. Chronic obstructive pulmonary disease is a clinical risk factor for pulmonary thromboembolism. The presentation of acute pulmonary thromboembolism and acute exacerbation of chronic obstructive pulmonary disease often mimic each other so closely that they cannot be distinguished clinically. The structural abnormalities of the lungs in chronic obstructive pulmonary disease make also difficult to interpret the results of noninvasive tests like ventilation-perfusion lung scans. Therefore, diagnosing acute pulmonary thromboembolism in patients with underlying chronic obstructive pulmonary disease is a challenging task. In order to update knowledge of the subject and offer suggestions regarding conduct, we evaluated various studies addressing this theme, including case reports and case series. In addition, we reviewed diagnostic approaches to acute pulmonary thromboembolism, and we reflect upon that topic. The clinical probability of pulmonary thromboembolism concomitant to chronic obstructive pulmonary disease is typically intermediate, as is positivity on the ventilation-perfusion lung scan. Diagnostic algorithms should take that into consideration.

Keywords: Pulmonary disease, chronic obstructive/complications; Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Ventilation-perfusion ratio

Objective: To evaluate the characteristics of smokers seeking treatment in a public smoking cessation program. Methods: This was a retrospective evaluation of data collected during the interview for enrollment in the smoking cessation program of the Smoking Outpatient Clinic of the Paulista State University School of Medicine in the city of Botucatu, Brazil, between April of 2003 and April of 2007. Demographic variables; previous use of the behavioral approach, medications or alternative treatments for smoking cessation; degree of nicotine dependence; and history of comorbidities were evaluated in 387 smokers. Results: In our sample, 63% of the smokers were female. The mean age of the subjects was 50 ± 25 years. More than half of the subjects (61%) had up to eight years of schooling, and 66% had a monthly income of less than twice the national minimum wage. The degree of nicotine dependence was high/very high in 59%, medium in 17% and low/very low in 24% of the subjects. Although 95% of the patients presented comorbidities, only 35% had been referred to the program by a physician. More than half of the subjects (68%) had made at least one smoking-cessation attempt, 83% of whom did so without the help of a structured program. Conclusions: Smokers seeking assistance for smoking cessation were socially disadvantaged, presented a high degree of nicotine dependence and had previously made smoking-cessation attempts without the benefit of a structured program. Therefore, in order to be effective, smoking control interventions should take into consideration the general characteristics of the smokers treated via the public health care system.

Keywords: Smoking; Tobacco use disorder; Smoking cessation.

Background: There is currently no consensus regarding which factors influence the quality of life of patients suffering from chronic obstructive pulmonary disease (COPD). However, identifying such factors could orient approaches to improving the quality of the lives of these patients. Objective: To evaluate factors that can interfere with quality of life in COPD patients selected for pulmonary rehabilitation. Methods: Twenty-one patients with moderate to severe COPD were evaluated. Maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), body mass index (BMI), pulmonary function, blood gases, grip strength (measured with a dynamometer), quadriceps strength and St. George's Respiratory Questionnaire (SGRQ) scores were assessed. Results: Statistically significant negative correlations with quality of life were found for the following factors: "impact" scores of: forced expiratory volume in one second (FEV1) (r = -0.68; p = 0.004), FEV1 to forced vital capacity ratio (FEV1/FVC) (r = -0.61; p = 0.014), peak expiratory flow (PEF) (r = -0.53 (p = 0.015), 6MWT (r = -0.63; p = 0.001) and BMI (r = -0.64; p = 0.002); "activity" scores for: MIP (r = -0.57; p = 0.007), baseline arterial oxygen saturation by pulse oximetry (SpO2) (r = -0.52; p = 0.018) and 6MWT (r = -0.58; p = 0.007); "symptom" score for: BMI (r = -0.60; p = 0.005); and "total" scores for: FEV1 (r = -0.64; p = 0.01), PEF (r = -0.47; p = 0.033) and BMI (r = -0.57; p = 0.009). Multiple linear regression revealed the primary factors influencing quality of life to be: BMI, which presented a significant influence on "symptom", "impact" and "total" scores (p = 0.002, p = 0.009 and p = 0.024, respectively); and 6MWT, which had a significant influence on "activity" and "impact" scores (p = 0.048 and p = 0.010, respectively). Conclusions: The BMI and 6MWT were shown to have an influence on quality of life in the COPD patients studied. Therefore, therapeutic approaches to improving the quality of life of COPD patients should take these indices into consideration.

Keywords: Lung diseases, obstructive/rehabilitation. Quality of life

Background: The six minutes walk test has been increasingly utilized to assess the effectiveness of different clinical and surgical treatment options in pulmonary diseases. However lack of standardization for their performance may influence measurements and jeopardize assessment of the functional capacity of patients with cardiopulmonary disease. Objective: To determine the possible effects of learning on the distance covered during the six minute walk test for bearers of chronic obstructive pulmonary disease. Method: A retrospective analysis of 35 medical records of COPD patients referred to the Pulmonary Rehabilitation Program of the University Hospital of Brasília was carried out. On alternate days these patients had performed two six minutes walk tests, spirometry and arterial blood gas analysis. Clinical and functional diagnosis was based upon the history of exposure to risk factors, mucus production, dyspnea and spirometric dysfunction after use of bronchodilators. The Student test was used for the comparison of results that were different. Results: The distances covered in the second six-minute walk test (515 ± 82 meters) were greater than those covered in the first six-minute walk test (480 ± 85 metros), with statistically significant differences (p<0.05). However measurements of the muscular effort and perception of dyspnea (Borg scale), peripheral blood oxygen saturation (SpO2), respiratory and heart rates did not disclose any statistically significant differences between the two tests (p<0.05). Conclusion: The present study suggests that in order to standardize the six minutes walk test, the procedure should be performed at least twice to better assess the functional capacity of patients, bearers of chronic obstructive pulmonary disease.

Keywords: Walking. Effectiveness. Lung diseases, obstrutive.

Objective: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease. Methods: This study was conducted at six medical centers across Brazil and included 109 patients from 33 to 82 years of age. Of those, 102 were randomized to receive either azithromycin (500 mg/day for three days, n = 49) or amoxicillin (500 mg every eight hours for ten days, n = 53). The patients were evaluated at the study outset, on day ten, and at one month. Based on the clinical evaluation of the signs and symptoms present on day ten and at one month, the outcomes were classified as cure, improvement, or treatment failure. The microbiological evaluation was made through the culture of sputum samples that were considered appropriate samples only after leukocyte counts and Gram staining. Secondary efficacy evaluations were made in order to analyze symptoms (cough, dyspnea, and expectoration) and pulmonary function. Results: There were no differences between the groups treated with azithromycin or amoxicillin in terms of the percentages of cases in which the outcomes were classified as cure or improvement: 85% vs. 78% (p = 0.368) on day ten; and 83% vs. 78% (p = 0.571) at one month. Similarly, there were no significant differences between the two groups in the secondary efficacy variables or the incidence of adverse effects. Conclusion: Azithromycin and amoxicillin present similar efficacy and tolerability in the treatment of acute exacerbation of chronic obstructive pulmonary disease.

Keywords: Amoxicillin/therapeutic use; Azithromycin/therapeutic use; Bronchitis, chronic/drug therapy;

Introduction: The term quality of life has gained increasing importance in the scientific context. This study describes the adaptation of a disease-specific questionnaire developed by Paul Jones et al. in 1991, the St. George's Respiratory Questionnaire (SGRQ), to the Brazilian language and culture. This questionnaire evaluates the quality of life in patients with chronic obstructive pulmonary disease (COPD) and contains three domains (symptoms, activity, and impacts) divided in 76 items. The questionnaire is self-administrated, but it may be read to illiterate persons. Goal: To verify if the St. George's Respiratory Questionnaire is a valid tool to measure quality of life in patients with chronic obstructive pulmonary disease in Brazil. Methods: In order to validate the questionnaire in Brazil, it was initially translated into Portuguese and afterwards a back-translation into English, that was compared to the original version. A final Portuguese version was then written. This final version was, then, answered by 30 clinically stable COPD patients, according to the spirometry and oximetry values. Patients answered the questionnaire twice, within a 15 day interval. The length of time the patients took to answer the questionnaire and their doubts were noted. Wilcoxon test was used for the calculation of r probability between every single question between the two days; interclass correlation ratio was calculated to test the trustworthiness and reliability of the questionnaire. Results: Among the 30 participant patients, 10 were female and 20 were male. Mean age was 65.9 years. Most of the patients were found to be in stage 2 (56.7 %) of COPD, according to the American Thoracic Society classification. The interclass correlation ratio for the total score of the questionnaire was a = 0.79 and Wilcoxon p = 0.2110 (not statistically significant). The mean answering time for the two days of interview was, respectively, 11 minutes and 50 seconds and 10 minutes and 31 seconds. As concerns the doubts about the questions, the patients reported difficulties in answering Sections 4 and 5, each one of these questions written in a negative form. Conclusion: It can be concluded that the Brazilian version of the St. George's Respiratory Questionnaire is a valid and reliable tool to measure quality of life in patients with COPD in Brazil.

Keywords: obstructive lung diseases, questionnaire, quality of life, reproducibility of results, evolution studies

Objective: To quantify elastic fibers (EFs) and smooth muscle (SM) cells, as well as CD4+ and CD8+ T lymphocytes, in stable chronic obstructive pulmonary disease (COPD). Methods: Surgical specimens were obtained from 15 COPD patients, 18 smokers without airflow limitation, and 14 nonsmokers. Histological and immunohistochemical methods were employed in order to quantify EFs, SM cells, CD4+ T cells, and CD8+ T cells. Results: There was no significant difference in EF numbers among the three groups (p > 0.05). The number of EFs per unit area of lung tissue (mm2) and the percentage of EFs in the lung tissue were similar among the three groups. The numbers of SM cells were found to be higher in the COPD patients than in the smokers (p = 0.003) or in the nonsmokers (p = 0.009). There was a tendency toward an increase in CD8+ T-cell counts in the COPD patients. In specimens collected from the COPD patients, CD4+ T-cell counts were lower than in those collected from the smokers (p = 0.015) or from the nonsmokers (p = 0.003). There was a weak correlation between CD4+ T-cell count and the ratio of forced expiratory volume in one second to forced vital capacity (r2 = 0.003). Conclusions: The EF counts were similar among the three groups. Hypertrophy/hyperplasia of airway wall SM cells was found in the COPD patients and in the smokers, indicating that airway remodeling occurs in smokers. The CD4/CD8 ratio was lower in the COPD patients.

Keywords: Pulmonary disease, chronic obstructive; CD4 Lymphocyte Count; Elastic tissue; Muscle, smooth.

Chronic obstructive pulmonary disease (COPD) is a public health problem. Tobacco smoking is the major cause, but not the only one. Air pollution, exposure to chemical compounds, environmental smoke exposure, and environmental tobacco smoke are among other contributing causes; viral and bacterial infection are risk factors too. Gender and weight loss are associated to the severity of the disease. Co-morbidity is frequent. Objective: To characterize a population of COPD outpatients followed at a tertiary medical service. Methods: Questionnaires were applied to patients with COPD. The data included gender, age, weight, body mass index (BMI), oxygen delivery users, and FEV1, exposure to tobacco smoke, exposure to wood smoke, tuberculosis antecedent and co-morbid diseases. Results: Of the 70 patients enrolled in the study, 70% (49) were male with an average age of 64 ± 10 years, an average weight of 63 ± 16 kg and an average BMI of 22 ± 5 kg/m2. 45,7% were oxygen dependent and the FEV1 average was 35 ± 14%. Nine (12.8%) patients never smoked, while 78.8% had quit tobacco smoking, (38 ± 11 pack/years was the average). Nine (12.8%) smoked straw cigarettes. Eighteen (25.7%) had environmental exposure to wood smoke. Eleven (15.7%) patients had tuberculosis, 5.7% complained of asthma symptoms, 2.8% had bronchiectasis, 11.4% diabetes mellitus, 51.4% hypertension, and 20% Cor pulmonale. Conclusion: Other possible COPD etiologies must be investigated. Determinants for the pulmonary injury could be environmental smoke exposure associated to former infections. Men with low BMI are typically representative of this severe patient population. Hypertension and Cor Pulmonale are frequent co-morbidity factors.

Chronic obstructive pulmonary disease is an inflammatory disease. Together with oxidant stimuli, which directly affect lung structures, macrophages, neutrophils and CD8+ lymphocytes actively participate in the pathogenesis of the disease and promote biochemical reactions that result in progressive alteration of the upper airways and irreversible lung remodeling. The release of substances promoted by inflammatory cell recruitment and by oxidative stress lead to a temporary imbalance in the pulmonary defense mechanisms. Understanding the long-term maintenance of this imbalance is key to understanding the current physiopathology of the disease. The present study explores the cellular and molecular alterations seen in chronic obstructive pulmonary disease.

Keywords: Pulmonary disease, chronic obstructive/physiopathology; Lung/metabolism; Inflammation; Oxydants; Antioxidants; Oxidative stress

Objective: To evaluate patient profiles and factors associated with successful treatment. Methods: A retrospective study of patients enrolled in the smoking cessation program at the Hospital de Messejana, located in the state of Ceará, Brazil, from October of 2002 to April of 2005. The treatment was evaluated based on patient profile, type of medication prescribed and time on that medication. Results: Of the 320 patients enrolled, 65.5% were women. The mean age at the outset of treatment was 48 years, and the mean duration of the smoking habit was 33 years. More than 90% of the patients had started smoking before the age of 20. Of the 258 individuals who had enrolled in the program at least one year prior, 50.8% had achieved treatment success; 17.8% had relapsed, and 31.4% had not quit smoking. On average, partial success was achieved in the fifth week of the treatment, and relapse occurred predominantly in the fourth month. Approximately 60% of the patients were treated with medication. Conclusion: Quitting smoking was significantly associated with the use of medication, regardless of the profile of the smoker evaluated. In the second year of the program, quitting smoking was more strongly associated with the use of bupropion and nicotine replacement, resulting in a higher success rate and a trend toward a reduction in the relapse rate.

Keywords: Smoking/therapy; Tobacco use cessation; Bupropion; Nicotine

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.

Keywords: Pulmonary disease, chronic obstructive/complications; Nutritional status; Exercise tolerance;

Objective: Making the differential diagnosis between asthma and chronic obstructive pulmonary disease (COPD) based on the response to inhaled bronchodilators by means of spirometry is controversial.The objective of this study was to identify the most useful spirometric variables in order to distinguish between asthma and COPD. Methods: Retrospective study conducted from April of 2004 to January of 2006, comparing the spirometric parameters of 103 nonsmoking patients with asthma to those of 108 patients with COPD who were smokers for more than 10 pack-years. All of the patients included in the study were older than 40 and presented stable disease at the time of the test. Results: Initial forced expiratory volume in one second (FEV1) was the same in the two groups (pre-bronchodilator FEV1 = 51%). However, patients with COPD were older (66 ± 9 years vs. 59 ± 11 years, p < 0.001) and more frequently male (73% vs. 27%, p < 0,001).After the use of the bronchodilator, the median absolute difference in FEV1 was 0.25 L (range, −0.09 to 1.13 L) in patients with asthma and 0.09 L (range, −0.1 to 0.73 L) in those with COPD (p < 0.001).The highest sensitivity (55%), specificity (91%) and likelihood ratio (6.1) for asthma diagnosis was obtained when the percentage increase in postbronchodilator FEV1 in relation to the predicted FEV1 (Δ%predFEV1) was equal to or greater than 10%.Isolated significant increases in forced vital capacity were more common in patients with COPD. Conclusions: In patients over the age of 40 and presenting obstructive lung disease, a Δ%predFEV1 ≥ 10% is the best spirometric parameter to distinguish asthma from COPD.

Keywords: Spirometry; Respiratory function tests; Lung diseases, obstructive.

Chronic obstructive pulmonary disease is highly prevalent the world over. An estimated 7% to 10% of the global adult population is affected. In Brazil, the incidence of chronic bronchitis is 12.7% among individuals over the age of 40. Economic studies have great relevance in devising policies for dealing with diseases of such high prevalence. The majority of data related to the costs of chronic obstructive pulmonary disease is culled from national health databases. There have been only a few studies evaluating the direct public health costs of the disease. In analyzing those studies, one can conclude that a chronic obstructive pulmonary disease patient generates a direct annual expenditure of 1200 to 1800 USD. However, the cost is correlated with the severity of the disease. Patients suffering from the more severe forms can require as much as double that expenditure, and early diagnosis is therefore vital. The most cost-effective strategy is early detection of the disease, in concert with anti-smoking campaigns. In the most advanced stages of the disease, the greatest costs are incurred due to hospitalization. In such cases, correct treatment of the acute exacerbations of the disease is crucial to minimizing costs. The average cost of a hospital stay in Brazil is 2761 Brazilian reals, which is equal to that of one full year of outpatient treatment. Antibiotic therapy accounts for only a small fraction of the total cost of treating such acute exacerbations. The use of more efficacious antibiotics may represent a more cost-effective strategy for reducing the rate of treatment failure. Economic analysis should allow for the identification and implementation of the most cost-effective strategies for treating this disease.

Keywords: Smoking/adverse effects. Tobacco use cessation/methods. Pregnancy.