Objective: To describe socioeconomic and behavioral aspects of pregnant women with asthma and to analyze the effects of maternal asthma on certain perinatal parameters in a birth cohort. Methods: An observational cross-sectional analytical study using data regarding the mothers of a birth cohort at maternity hospitals in the greater metropolitan area of Aracaju, Brazil, between the 8th of March and the 15th of July of 2005. In the pregnant women, asthma was self-reported, based on previous medical diagnosis. Epidemiological, obstetric and perinatal variables were studied. Results: Of the 4,757 mothers included in the study, 299 (6.3%) had asthma. The mothers with asthma had lower family incomes and more frequently made use of the public health care system (for prenatal care and delivery) than did those without asthma. Although only 9.4% of the mothers with asthma smoked and only 27.6% consumed alcoholic beverages, these proportions were higher than were those observed for the control group. Asthma was not found to be associated with obstetric problems or with problems involving the neonates. Nor did we find asthma to be associated with cesarean delivery, prematurity or small-for-gestational-age neonates. Conclusions: Low socioeconomic level seems to be a risk factor for asthma.

Keywords: Asthma; Pregnancy; Socioeconomic factors; Infant, newborn.

Pregnancy is a special occasion to promote the end of the smoking habit. Concern with health of the fetus brings about an extraordinary motivation for the pregnant woman. Results and cost-effectiveness of interventions are better in this group than in the overall population and the advantages extrapolate the benefits to the woman's health as they also allow for the development of a healthy fetus. Knowledge of the peculiarities of smoking during pregnancy is fundamental for a directed approach which adds to a probability of greater success. This review investigates the extent of the harm of tobacco for the pregnant woman as well as for the fetus. As such it, it encourages the use of appropriate techniques to urge pregnant women to stop smoking.

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

Objective: Pregnancy brings about significant changes in respiratory function, as evidenced by alterations in lung volumes and capacities, which are attributable to the mechanical impediment caused by the growing foetus. This study was undertaken in order to identify changes in respiratory function during normal pregnancy and to determine whether such changes are more pronounced in twin pregnancy than in singleton pregnancy. Methods: Respiratory function was assessed in 50 women with twin pregnancies and in 50 women with singleton pregnancies (during the third trimester in both groups), as well as in 50 non-pregnant women. We measured the following pulmonary function test parameters: FVC; FEV1; PEF rate; FEV1/FVC ratio; FEF25-75%; and maximal voluntary ventilation. Results: All respiratory parameters except the FEV1/FVC ratio were found to be lower in the pregnant women than in the non-pregnant women. We found no significant differences between women with twin pregnancies and those with singleton pregnancies, in terms of respiratory function. Conclusions: Despite its higher physiological demands, twin pregnancy does not appear to impair respiratory function to any greater degree than does singleton pregnancy.

Keywords: Respiratory function tests; Respiratory mechanics; Pregnancy, twin; Pregnancy.

Objective: To investigate how social and psychological characteristics differ between pregnant women who smoke and do not smoke. To explore associations between social and psychological features with changes of smoking habits by the end of pregnancy. Methods: A case-control study was set up. Smokers cases were never-smokers and ex-smokers controls. Pregnant women (n=328) from public prenatal services were interviewed. Socio-demographic data and psychological variables - personality traits, anxiety, depression, perceived stress, maternal fetal-attachment - were measured. Saliva samples were collected to measure cotinine and to check self-informed smoking status. In addition, 66 smokers were also assessed regarding smoking habits by late pregnancy. Smoking status was defined as a dependent variable. Exposure factors were analyzed through odds ratios. Logistic models and contingency tables were employed according to the nature of variables. "Qualitative change in smoking" was defined as a dependent variable for the last evaluation, and a logistic regression model was built. Results: Lower schooling, higher age, use of alcohol and drugs, living without a partner, and passive smoking showed associations with smoking. Anxiety, depression and perceived stress also exhibited positive association with smoking. Among personality traits, only Neuroticism was associated with smoking. None of the variables were associated with qualitative change in smoking by the end of pregnancy. Conclusion: Smoking during pregnancy is associated with more unfavorable social conditions. Pregnant women who smoke exhibit more negative psychological states than nonsmokers, including a profile of accentuated Neuroticism. None of the investigated variables could predict changes in smoking during pregnancy.

Keywords: Smoking; Pregnancy; Psychology; Psychosocial factors; Personality traits; Big five factor model of personality; Perceived stress; Anxiety; Depression.

Objective: To determine the occurrence of cardiorespiratory alterations and to identify adverse events during the intrahospital transport of patients on invasive ventilation. Methods: A prospective observational non-randomized study was conducted at two tertiary hospitals between April of 2005 and December of 2006. We included patients on invasive ventilation who required intrahospital transport during the study period. Exclusion criteria were as follows: being under suspicion of brain death; being submitted to alternate periods of mechanical ventilation/nebulization via a T-piece; and being transported to the operating room. Prior to and after transport, we evaluated blood gas analysis results, vital signs, use of medications by means of a continuous infusion pump, parameters regarding the mechanical ventilator, duration of transport, transport distance and number of professionals involved. Results: We included 48 patients in a total of 58 intrahospital transports. Relevant cardiorespiratory alterations were identified in 39 transports, totaling 86 episodes, as well as 16 adverse events related to equipment or personnel failure, such as problems related to batteries and to miscommunication. Conclusions: During the intrahospital transport of patients on invasive ventilation, cardiorespiratory alterations were common (67.2%), and adverse events occurred in 75.7% of the transports.

Keywords: Patient transfer; Intensive care; Respiration, artificial; Ventilators, mechanical.

Objective: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. Methods: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. Results: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. Conclusions: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])

Keywords: Abdominoplasty; Lipectomy; Ultrasonography; Diaphragm/physiology; Diaphragm/physiopathology; Lung/physiology; Lung/physiopathology; Respiratory mechanics; Spirometry; Respiratory function tests.

Objective: To examine the pattern of tobacco use and knowledge about tobacco-related diseases, as well as to identify popular types of electronic media, in pregnant women, in order to improve strategies for the prevention or cessation of smoking among such women. Methods: A cross-sectional study involving 61 pregnant women, seen at primary care clinics and at a university hospital, in the city of Botucatu, Brazil. For all subjects, we applied the Hospital Anxiety and Depression Scale. For subjects with a history of smoking, we also applied the Fagerström Test for Nicotine Dependence, and we evaluated the level of motivation to quit smoking among the current smokers. Results: Of the 61 pregnant women evaluated, 25 (40.9%) were smokers (mean age, 26.4  7.4 years), 24 (39.3%) were former smokers (26.4  8.3 years), and 12 (19.8%) were never-smokers (25.1  7.2 years). Thirty-nine women (63.9%) reported exposure to passive smoking. Of the 49 smokers/former smokers, 13 (26.5%) were aware of the pulmonary consequences of smoking; only 2 (4.1%) were aware of the cardiovascular risks; 23 (46.9%) believed that smoking does not harm the fetus or newborn infant; 21 (42.9%) drank alcohol during pregnancy; 18 (36.7%) reported increased cigarette consumption when drinking; 25 (51.0%) had smoked flavored cigarettes; and 12 (24.5%) had smoked a narghile. Among the 61 pregnant women evaluated, television was the most widely available and favorite form of electronic media (in 85.2%), as well as being the form most preferred (by 49.2%). Conclusions: Among pregnant women, active smoking, passive smoking, and alternative forms of tobacco consumption appear to be highly prevalent, and such women seem to possess little knowledge about the consequences of tobacco use. Educational programs that include information about the consequences of all forms of tobacco use, employing new and effective formats tailored to this particular population, should be developed, in order to promote smoking prevention and cessation among pregnant women. Further samples to explore regional and cultural adaptations should be evaluated.

Keywords: Pregnancy; Health knowledge, attitudes, practice; Smoking; Mass media; Smoking cessation; Primary prevention.

Objective: To assess the 24-month effects of a pulmonary rehabilitation program (PRP) on anxiety, depression, quality of life and physical performance of COPD patients. Methods: Thirty patients with COPD (mean age, 60.8 ± 10 years; 70% males) participated in a 12-week PRP, which included 24 physical exercise sessions, 24 respiratory rehabilitation sessions, 12 psychotherapy sessions and 3 educational sessions. All patients were evaluated at baseline (pre-PRP), at the end of the treatment (post-PRP) and two years later (current) by means of four instruments: the Beck Anxiety Inventory; the Beck Depression Inventory; Saint George's Respiratory Questionnaire; and the six-minute walk test (6MWT). Results: The comparison between the pre-PRP and post-PRP values revealed a significant decrease in the levels of anxiety (pre-PRP: 10.7 ± 6.3; post-PRP: 5.5 ± 4.4; p = 0.0005) and depression (pre-PRP: 11.7 ± 6.8; post-PRP: 6.0 ± 5.8; p = 0.001), as well as significant improvements in the distance covered on the 6MWT (pre-PRP: 428.6 ± 75.0 m; post-PRP: 474.9 ± 86.3 m; p = 0.03) and the quality of life index (pre-PRP: 51.0 ± 15.9; post-PRP: 34.7 ± 15.1; p = 0.0001). There were no statistically significant differences between the post-PRP and current evaluation values. Conclusions: The benefits provided by the PRP in terms of the indices of anxiety, depression and quality of life, as well as the improved 6MWT performance, persisted throughout the 24-month study period.

Keywords: Pulmonary disease, chronic obstructive; Rehabilitation; Exercise; Quality of life; Anxiety; Depression.

We report the case of a 25-year-old woman with Churg-Strauss syndrome, the symptoms of which had first appeared soon after she began taking oral contraceptive at the age of sixteen. The clinical profile evolved rapidly to severe persistent asthma, nasal polyposis, perennial obstructive rhinitis, eosinophilia (peripheral/tissue) and mononeuritis. Churg-Strauss syndrome is the type of disease that demands early detection, accurate diagnosis, aggressive treatment and periodic monitoring. It should be considered in the differential diagnosis of moderate and severe persistent asthma. The case reported calls attention to possibility that there is a hormonal component and that the disease can present early onset.

Keywords: Asthma; Churg-Strauss syndrome; Eosinophilia; Nasal polyps; Vasculitis; Case reports [publication type]

Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma.

Pulmonary alveolar microlithiasis (PAM) is a rare disease that affects both lungs. It is characterized by the presence of small calculi (calcium phosphate) within the alveolar spaces. We report the case of a 26-year-old female whose diagnosis was based on characteristic findings on chest X-rays and high-resolution computed tomography scans. The patient, 28 weeks pregnant, was rehospitalized 10 months after the diagnosis, presenting hypoxemic acute respiratory failure and severe restrictive ventilatory defect on spirometry. After 32 completed weeks of gestation (228 days), she was submitted to cesarean section, and the outcome was successful for mother and newborn. PAM has a variable clinical course. It is suggestive of an autosomal recessive inheritance pattern and has been associated with positive family history. The etiology of PAM is unclear, and many authors speculate that there is a local enzymatic defect responsible for the intra-alveolar accumulation of calcium. Reports of patients with PAM who become pregnant are exceptional, and this is the first case described in Brazil. The course of this disease is usually slow and progressive, and patients typically die of cardiorespiratory failure. The present case illustrates the need to offer female patients, especially those with advanced disease, genetic counseling and orientation regarding the risks of pregnancy. Currently, the only effective therapy is lung transplantation.

Keywords: Pulmonary alveoli; Pregnancy; Respiratory insufficiency.