Revista Portuguesa de Pneumologia (English Edition)最新文献

This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases.

Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach.

In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged.

Introduction

Transbronchial lung cryobiopsy (TBC) has emerged as a diagnostic alternative to surgical lung biopsy in interstitial lung disease (ILD). Despite its less invasive nature, some associated complications have been described.

Objective

To evaluate complications of TBC and associated factors.

Methods

Prospective evaluation of all patients with ILD submitted to TBC in our centre. Clinicodemographic variables and factors associated to TBC complications were analyzed. The effect of the variables on the complication risk was evaluated by a logistic regression model.

Results

Ninety patients were included (mean age 60 ± 13 years; 58.9% male). Twenty-two patients presented pneumothorax, 18 (81.8%) of which were treated with chest tube drainage [median air leak time: 1 day (IQR = 2)]. Grade 2 and 3 bleeding was observed in 13 (14.4%) cases. Presence of visceral pleura in the sample accounted for almost more than 10 times the odds of pneumothorax (OR = 9.59, 95% CI 2.95–31.17, p < 0.001). Increased body mass index (BMI) was associated with bleeding (16% additional odds for each BMI unit increase (OR = 1.16, 95% CI 1.01–1.34, p = 0.049).

Conclusion

The most frequent complication of TBC was pneumothorax, although rapidly reversible. There was a positive association between pneumothorax and the presence of pleura in the biopsy samples as well as between bleeding and increased BMI. More studies about TBC complications are needed to improve the selection of the candidates for this procedure.

Objective

To identify changes in the forced and quiet breathing parameters of lung function in healthy children and adolescents exposed to passive smoking (PS).

Method

Comparative cross-sectional study. Healthy schoolchildren aged 6 to 14 years. We collected anthropometric data, lung function parameters using spirometry (forced breathing), and quiet breathing parameters using impulse oscillometry. The sample was divided into two groups according to exposure to PS: passive smoking group (PSG) and non-passive smoking group (NPSG). For the statistical analysis, the Shapiro–Wilk test was used to verify data normality and the T-test or Mann–Whitney test to compare spirometric and oscillometric parameters between groups (p ≤ 0.05).

Main findings

The study included 78 children and adolescents, with 14 boys and 25 girls in each group. There were differences in the mean values for peak expiratory flow (p = 0.01). There were no significant differences between the groups in values for z-score and lower limit of normal. The PSG had higher mean absolute values for reactance area (X5 = 0.05) and significant percentage of predicted values for the following impulse oscillometry parameters: central airway resistance (R20%, p = 0.03) and for the indicators of presence of airway obstruction (Fres%, p = 0.01; X5% = 0.01% and AX%, p = 0.01).

Conclusion

Children and adolescents exposed to PS had lower values for the spirometric variables and higher values for the oscillometric variables, indicating changes in forced and quiet parameters of lung function compared to the NPSG.

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) was recognized as a rare new entity. We report the case of a 63 years old female suffering from progressive dyspnea and dry cough for three years. Two years before admission to our hospital, idiopathic pulmonary fibrosis (IPF) was diagnosed in another hospital and treatment with prednisolone and N-acetylcysteine (NAC) was commenced. At admission HRCT showed upper lobe dominant fibrosis and associated pleural thickening. Surgical biopsies were re-evaluated and revealed fibroelastosis with pleural thickening and a probable UIP pattern, consistent with idiopathic PPFE. Treatment with pirfenidone was initiated due to progression under prednisolone and NAC. Upper lobe predominant pleural thickening with associated subpleural fibrotic changes should raise suspicion of PPFE.

Introduction

Asthma is one of the most frequent chronic diseases, putting a considerable economic burden on societies and individuals. We aimed to estimate the total cost of adult asthma in Portugal, as well as the extent to which direct and indirect costs are influenced by the level of asthma control.

Methods

A nationwide, prevalence-based, cost-of-illness study using a bottom-up approach to calculate direct and indirect costs of asthma was conducted, using participant data from the Portuguese National Asthma Survey (INAsma). Direct (healthcare service usage, diagnostic tests and treatment) and indirect (absenteeism and transportation) costs were measured. Decision analytic modelling was used to perform multivariate deterministic sensitivity analysis.

Results

On average, each adult costs 708.16€ (95%CI: 594.62–839.30) a year, with direct costs representing 93% (658.46€; 95%CI: 548.99–791.29) and indirect costs representing 7% (49.70€; 95%CI: 32.08–71.56). This amounts to a grand total of 386,197,211.25€ (95%CI: 324,279,674.31–457,716,500.18), with direct costs being 359,093,559.82€ (95%CI: 299,391,930.03–431,533,081.07). Asthma direct costs are 2.04% of the total Portuguese healthcare expense in 2010. The major cost domains were acute care usage (30.7%) and treatment (37.4%). Asthma control was significantly associated with higher costs throughout several domains, most notably in acute medical care.

Conclusions

Asthma in adults poses a significant economic burden on the Portuguese healthcare system, accounting for over 2% of the total healthcare expenditure in Portugal in 2010. It is important to note that a considerable portion of this burden might be eased by improving asthma control in patients, as uncontrolled patients’ costs are more than double those of controlled asthma patients.