2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy.

Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations.

Continuous Monitoring of Pulse Oximetry During the 6-Minute Walk Test Improves Clinical Outcomes Prediction in COPD.

Background: Continuous monitoring of S throughout the 6-min walk test (6MWT) unveiled that some patients with respiratory diseases may present values across the test lower than S measured at the end of the test. Nevertheless, it remains unclear whether this approach improves the yield of walk-induced desaturation detection in predicting mortality and hospitalizations in patients with COPD.

Methods: Four hundred twenty-one subjects (51% males) with mild-very severe COPD underwent a 6MWT with continuous measurement of S .

Aerobic Exercise Increases Vascular Diameter of Arteriovenous Fistula in Hemodialysis Patients.

Introduction: A healthy arteriovenous fistula (AVF) depends on adequate vessel diameter which can be maintained through aerobic exercises. A randomized crossover study was conducted to evaluate the acute effects of aerobic exercise on a cycle ergometer on AVF vascular diameter, through ultrasound, and on blood pressure (BP).

Methods: Eight hemodialysis (HD) patients completed 2 different occasions in random order with a 7-day washout: (a) exercising moment, in which 30-min aerobic exercise was performed on a cycle ergometer; and (b) resting moment, which was performed 30-min with the patient sitting in a chair.

The relationship between height of vertical jumps, functionality and fall episodes in patients with chronic obstructive pulmonary disease: A case-control study.

This study aimed to compare the height of jumps and functional parameters in patients with chronic obstructive pulmonary disease (COPD) to those in healthy people, in addition to assessing the relationship among variables in patients with COPD. Twenty patients with COPD (forced expiratory volume [FEV1] % of predicted: 39.98 ± 11.

Occupational exposure to crystalline silica and peripheral biomarkers: An update.

Peripheral biomarkers are important tools for detecting occupational exposures to prevent the onset and/or progression of diseases. Studies that reveal early peripheral biomarkers are highly important to preserve the health of workers and can potentially contribute to diagnosing and/or prognosing occupational pathologies. Exposure to crystalline silica is a problem in several workplaces because it increases the risk of chronic obstructive pulmonary disease (COPD), tuberculosis, cancer, and pulmonary fibrosis, clinically defined as silicosis.

Predictors of health-related quality of life among semi-precious stone mineworkers exposed to silica dust.

Objective: The study aimed to comparatively evaluate HRQOL in miners of semi-precious stones with and without silicosis, and determine the associated factors, as well as the performance of two different questionnaires in measuring HRQOL.

Methods: In a cross-sectional study of 348 male miners (129 with silicosis) who underwent an interview and spirometry, HRQOL was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire and the Saint George's Respiratory Questionnaire (SGRQ).

Results: Miners with silicosis were older, had less schooling, worked more hours daily, and had longer exposure to silica.

Phase Angle Evaluation of Lung Disease Patients and Its Relationship with Nutritional and Functional Parameters.

Background: This study aimed to determine the value of phase angle (PhA) in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) and its association with nutritional and functional parameters.

Methods: A cross-sectional study of 77 patients under follow-up at the pulmonary outpatient clinic of a public hospital. Anthropometric measurements and functional assessments of physical and pulmonary capacity were performed, and a regular physical activity questionnaire was administered.

Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis.

Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the effects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD.

Lung function and functional exercise capacity in underground semi-precious stone mineworkers.

Background: Semi-precious stone mining may cause occupational lung disease. The impact of inhaling silica on workers' exercise capacity has only been partially studied.

Objectives: To study lung function, exercise capacity, and identify factors associated with functional impairment.

Altered Gut Microbiome Profile in Patients With Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is considered a disease of the pulmonary vasculature. Limited progress has been made in preventing or arresting progression of PAH despite extensive efforts. Our previous studies indicated that PAH could be considered a systemic disease since its pathology involves interplay of multiple organs.

Hepatopulmonary syndrome has low prevalence of pulmonary vascular abnormalities on chest computed tomography.

Purpose: Hepatopulmonary syndrome (HPS) is defined as an arterial oxygenation defect induced by intrapulmonary vascular dilatations associated with hepatic disease. This study aimed to assess the prevalence of type 1 and 2 pulmonary vascular abnormalities on chest computed tomography (CT) in patients with cirrhosis and HPS and to characterize intra- and interobserver reliability.

Materials And Methods: Two thoracic radiologists retrospectively evaluated chest CT scans from 38 cirrhosis patients with HPS.

Tidal Flow-Volume Loop Enveloping at Rest in Advanced COPD.

Background: Expiratory flow limitation (EFL) is a key physiological abnormality in COPD. Comparing tidal-to-maximum flow-volume (F-V) loops is a simple and widely available method to assess EFL in patients with COPD. We aimed to investigate whether subjects with COPD showing significant resting tidal F-V enveloping (ie, > 50% tidal volume) would present with higher exertional operating lung volumes, which would lead to greater burden of dyspnea and poorer exercise tolerance compared to their counterparts.

Lung Ultrasound Prior to Spontaneous Breathing Trial Is Not Helpful in the Decision to Wean.

Background: Lung ultrasound is increasingly becoming a diagnostic tool in the critical care setting. B-pattern on a lung ultrasound is an artifact composed of multiple B-lines and correlates with interstitial edema. A randomized controlled trial concluded that bedside thoracic ultrasound could predict postextubation distress through changes in lung aeration during a weaning procedure; however, it could not screen patients before performance of a spontaneous breathing trial (SBT).

Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.

AimTo investigate if cardiac/pulmonary functional tests and variables obtained from clinical practice (body mass index, dyspnea, functional class, clinical judgment of disability to perform an exercise test and previous hospitalization rate) are related to mortality in patients with overlap chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). BACKGROUND: Although the coexistence of COPD and CHF has been growingly reported, description of survival predictors considering the presence of both conditions is still scarce. METHODS: Using a cohort design, outpatients with the previous diagnosis of COPD and/or CHF that performed both spirometry and echocardiography in the same year were followed-up during a mean of 20.

Usefulness of radiological signs of pulmonary congestion in predicting failed spontaneous breathing trials.

Inspiratory fall in intrathoracic pressure during a spontaneous breathing trial (SBT) may precipitate cardiac dysfunction and acute pulmonary edema. We aimed to determine the relationship between radiological signs of pulmonary congestion prior to an SBT and weaning outcomes. This was a post hoc analysis of a prospective cohort study involving patients in an adult medical-surgical ICU.

Behavior of lung ultrasound findings during spontaneous breathing trial.

Objective: We aimed to investigate a potential association between B-lines and weaning failure.

Methods: Fifty-seven subjects eligible for ventilation liberation were enrolled. Patients with tracheostomy were excluded.

Effects of Expiratory Positive Airway Pressure on Exercise Tolerance, Dynamic Hyperinflation, and Dyspnea in COPD.

Introduction: The application of expiratory positive airway pressure (EPAP) in patients with COPD during exercise may reduce dynamic hyperinflation, while, on the other hand, it can increase the resistive work of breathing. Therefore, we evaluated the effects of 2 intensities of EPAP during exercise on tolerance, dynamic hyperinflation, and dyspnea in subjects with moderate to very severe COPD.

Methods: We performed a cross-sectional, experimental, 4-visit study.

Effectiveness assessment of a guideline based protocol for ventilatory support management of COPD exacerbations in an emergency department.

Objectives: To investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a "real-life" Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation.

Methods: Retrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation).

Results: 117 consecutive chronic obstructive pulmonary disease exacerbation admissions (Group A=96; Group B=13; Group C=8) of candidates for ventilatory support were reviewed.

Silicosis prevalence and risk factors in semi-precious stone mining in Brazil.

Background: Underground mining generates large amounts of dust and exposes workers to silica. This study aims to determine the prevalence and predictor factors for the development of silicosis among semi-precious-stone mineworkers in southern Brazil working in a self-administered cooperative.

Methods: In a cross-sectional study of 348 current workers and retirees, demographic data, medical, and occupational history were collected through an interview performed by a nurse and medical record review.

Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism.

Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA.

Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE.

Inspiratory loading and limb blood flow in COPD: The modulating effects of resting lung hyperinflation.

Inspiratory resistive loading (IRL) may have deleterious cardiocirculatory effects leading to poor peripheral perfusion in severely-hyperinflated patients with COPD. Nineteen patients (13 severely-hyperinflated with inspiratory capacity/total lung capacity ratio≤0.28) underwent calf blood flow (CBF) measurements by venous occlusion plethysmography at rest and during IRL at 60% maximal inspiratory pressure.

Effect of 6-minute walk test on neuromuscular properties of patients with chronic obstructive pulmonary disease.

Objective: The objective of this study was to evaluate the neuromechanical properties of the knee extensor muscles before and after the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients and control subjects.

Materials And Methods: COPD patients from the Department of Pulmonology of the Hospital de Clinicas de Porto Alegre and age- and sex-matched control volunteers without COPD were included in this study. Body composition and lower limb strength assessed by maximal voluntary isometric contraction (MVIC) of the knee extensors) were assessed before and after the 6MWT.