RAFAEL STELMACH

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina

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  • article
    Efeito agudo do salbutamol no sistema cardiovascular durante o exercício físico em pacientes com asma moderada ou grave: estudo aleatorizado, duplo-cego e cruzado
    (2018) MELO, Jaqueline Ribas de; FEITOZA, Maiane da Silva; CUCATO, Gabriel Grizzo; MEDEIROS, Wladimir Musetti; STELMACH, Rafael; CUKIER, Alberto; CARVALHO, Celso Ricardo Fernandes de; MENDES, Felipe Augusto Rodrigues
    ABSTRACT Salbutamol is a β2-agonist of short duration commonly used in patients with asthma to prevent symptoms during or after exercise. Hemodynamic changes at rest are well described. However, there is little data on the effects on heart rate (HR) and blood pressure (BP) during exercise and recovery phase in patients with moderate or severe asthma A randomized, double-blind, cross-over study was conducted, including 15 individuals with moderate and severe asthma, mean age 46.4±9.3 years. Patients underwent a maximal 2-day exercise test with 400 mcg salbutamol or 4 placebo puffs. Throughout the protocol, HR, BP, perceived exertion and peak of expiratory flow (PEF) were monitored. After the use of salbutamol, the PEF value increased by a mean of 28.0±47.7L/m, remaining increased at 5, 10 and 15 minutes of passive recovery compared to placebo (p<0.05). The HR, BP and effort perception variables were similar across interventions at all stages of the protocol (p>0.05). These results suggest that the use of salbutamol is safe and that HR does not need to be adjusted to prescribe exercise intensity following salbutamol administration in subjects with moderate or severe asthma.
  • article 26 Citação(ões) na Scopus
    Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis
    (2018) CAMARGO, Anderson Alves de; BOLDORINI, Jacqueline C.; HOLLAND, Anne E.; CASTRO, Rejane A. Silva de; LANZA, Fernanda de Cordoba; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CARVALHO-PINTO, Regina; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone Dal
    Background. Bronchiectasis is characterized by a progressive structural lung damage, recurrent infections and chronic inflammation which compromise the exertion tolerance, and may have an impact on skeletal muscle function and physical function. Objective. The purpose of this study was to compare peripheral muscle strength, exercise capacity, and physical activity in daily life between participants with bronchiectasis and controls and to investigate the determinants of the peripheral muscle strength and physical activity in daily life in bronchiectasis. Design. This study used a cross-sectional design. Methods. The participants' quadriceps femoris and biceps brachii muscle strength was measured. They performed the incremental shuttle walk test (ISWT) and cardiopulmonary exercise testing, and the number of steps/day was measured by a pedometer. Results. Participants had reduced quadriceps femoris muscle strength (mean difference to control group = 7 kg, 95% CI = 3.8-10.1 kg), biceps brachii muscle strength (2.1 kg, 95% CI = 0.7-3.4 kg), ISWT (227 m, 95% CI = 174-281 m), peak VO2 (6.4 ml/Kg/min, 95% CI = 4.0-8.7 ml/Kg/min), and number of steps/day (3,332 steps/day, 95% CI = 1,758-4,890 steps/day). A lower quadriceps femoris strength is independently associated to an older age, female sex, lower body mass index (BMI), higher score on the modified Medical Research Council scale, and shorter distance on the ISWT (R-2 = 0.449). Biceps brachii strength is independently associated with sex, BMI, and dyspnea (R-2 = 0.447). The determinants of number of daily steps were dyspnea and distance walked in ISWT, explaining only 27.7% of its variance. Limitations. Number of steps per day was evaluated by a pedometer. Conclusion. People with bronchiectasis have reduced peripheral muscle strength, and reduced aerobic and functional capacities, and they also are less active in daily life. Modifiable variables such as BMI, dyspnea, and distance walked on the ISWT are associated with peripheral muscle strength and physical activity in daily life.
  • article 11 Citação(ões) na Scopus
    Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers
    (2018) CRUZ, Alvaro A.; CAMARGOS, Paulo A.; URRUTIA-PEREIRA, Marilyn; STELMACH, Rafael
  • conferenceObject
    Identification of asthma phenotypes using cluster analysis
    (2018) FREITAS, Patricia D.; XAVIER, Rafaella F.; SILVA, Simone T. C. da; CARVALHO-PINTO, Regina M.; STELMACH, Rafael; CUKIER, Alberto; MARTINS, Milton A.; CARVALHO, Celso R. F.
  • conferenceObject
    Using a rapid prioritisation process to identify health research priorities in LMICs
    (2018) DICKENS, Andy; ADAB, Peymane; CHENG, Kar; CHI, Chunhua; COOPER, Brendan; SOUSA, Jaime Correia De; ENOCSON, Alexandra; FARLEY, Amanda; GALE, Nicola; JOLLY, Kate; JOWETT, Sue; MAGLAKELIDZE, Mariam; MAGLAKELIDZE, Tamaz; MARTINS, Sonia; RISTOVSKA, Radmila; SITCH, Alice; STAVRIKJ, Katarina; STELMACH, Rafael; TURNER, Alice; WILLIAMS, Sian; JORDAN, Rachel
  • conferenceObject
    Non Concordance Between Sputum and Pulmonary Explant Fragments Culture in Patients with Cystic Fibrosis After Lung Transplantation
    (2018) ATHANAZIO, R. A.; RACHED, S. Z.; STELMACH, R.; CUKIER, A.; CARVALHO-PINTO, R. M.; COSTA, A. N.; FERNANDES, F. L.; SAMANO, M. N.; TEIXEIRA, R. H.; CAMPOS, S. V.
  • article 23 Citação(ões) na Scopus
    COPD Assessment Test (CAT) is a Valid and Simple Tool to Measure the Impact of Bronchiectasis on Affected Patients
    (2018) LANZA, Fernanda C.; CASTRO, Rejane A. S.; CAMARGO, Anderson A. de; ZANATTA, Drielly J. M.; RACHED, Samia; ATHANAZIO, Rodrigo; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone Dal
    The COPD assessment test (CAT) is a short questionnaire developed to help patients and clinicians to assess the impact of symptoms in routine clinical practice. We aimed to validate and to test the reproducibility of CAT in patients with bronchiectasis and correlate with the severity of dyspnea, aerobic and functional capacity, and physical activity in daily life. This is a cross-sectional study, patients with bronchiectasis underwent spirometry, cardiopulmonary exercise test (CPET), incremental shuttle walk test (ISWT), Saint George`s Respiratory Questionnaire (SGRQ), and received pedometer. CAT was applied twice (CAT-1 and CAT-2, 7 to 10 days apart). The severity of bronchiectasis was assessed by E-FACED and bronchiectasis severity index (BSI). A total of 100 patients were evaluated (48 +/- 14 years, 59 women, FVC: 67 +/- 22% pred, FEV1: 52 +/- 25% pred). According to CAT, 14% patients presented low, 40% medium, 32% high, and 14% very high impact. The higher the CAT, the worse the severity of bronchiectasis, dyspnea, quality of life, performance on the CPET, and smaller the distance walked (DW) on the ISWT and number of steps (NS) per day. There was significant correlation between CAT and SGRQ, E-FACED, BSI, NS, ISWT, oxygen uptake, and workload at CPET. CAT-1 and CAT-2 presented similar values: 21 (13-26) and 19 (13-26), respectively. The CAT is a valid and reproducible instrument in patients with bronchiectasis presenting good correlation with clinical, functional, and quality of life measurements. This easy-to-use, easy-to-understand, quick, and useful tool may play an important role to assess the impact of bronchiectasis on both daily medical practice and clinical trial settings.
  • article 71 Citação(ões) na Scopus
    Daily allergic multimorbidity in rhinitis using mobile technology: A novel concept of the MASK study
    (2018) BOUSQUET, J.; DEVILLIER, P.; ANTO, J. M.; BEWICK, M.; HAAHTELA, T.; ARNAVIELHE, S.; BEDBROOK, A.; MURRAY, R.; EERD, M. van; FONSECA, J. A.; ALMEIDA, M. Morais; BOM, A. Todo; MENDITTO, E.; PASSALACQUA, G.; STELLATO, C.; TRIGGIANI, M.; VENTURA, M. T.; VEZZANI, G.; ANNESI-MAESANO, I.; BOURRET, R.; BOSSE, I.; CAIMMI, D.; CARTIER, C.; DEMOLY, P.; JUST, J.; PORTEJOIE, F.; SIROUX, V.; VIART, F.; BERGMANN, K. C.; KEIL, T.; KLIMEK, L.; MOESGES, R.; PFAAR, O.; SHAMAI, S.; ZUBERBIER, T.; MULLOL, J.; VALERO, A.; SPRANGER, O.; TOMAZIC, P. V.; KOWALSKI, M. L.; KUNA, P.; KUPCZYK, M.; RACIBORSKI, F.; SAMOLINSKI, B.; TOPPILA-SALMI, S. K.; VALOVIRTA, E.; CRUZ, A. A.; SARQUIS-SERPA, F.; SILVA, J. da; STELMACH, R.; LARENAS-LINNEMANN, D.; GONZALEZ, M. Rodriguez; CABANAS, M. T. Burguete; KVEDARIENE, V.; VALIULIS, A.; CHAVANNES, N. H.; FOKKENS, W. J.; RYAN, D.; SHEIKH, A.; BACHERT, C.; HELLINGS, P. W.; VANDENPLAS, O.; BALLARDINI, N.; KULL, I.; MELEN, E.; WESTMAN, M.; WICKMAN, M.; BINDSLEV-JENSEN, C.; ELLER, E.; BOSNIC-ANTICEVICH, S.; O'HEHIR, R. E.; AGACHE, I.; BIEBER, T.; CASALE, T.; GEMICIOGLU, B.; IVANCEVICH, J. C.; VRIES, G. De; SORENSEN, M.; YORGANCIOGLU, A.; LAUNE, D.
    BackgroundMultimorbidity in allergic airway diseases is well known, but no data exist about the daily dynamics of symptoms and their impact on work. To better understand this, we aimed to assess the presence and control of daily allergic multimorbidity (asthma, conjunctivitis, rhinitis) and its impact on work productivity using a mobile technology, the Allergy Diary. MethodsWe undertook a 1-year prospective observational study in which 4 210 users and 32585days were monitored in 19 countries. Five visual analogue scales (VAS) assessed the daily burden of the disease (i.e., global evaluation, nose, eyes, asthma and work). Visual analogue scale levels <20/100 were categorized as ""Low"" burden and VAS levels 50/100 as ""High"" burden. ResultsVisual analogue scales global measured levels assessing the global control of the allergic disease were significantly associated with allergic multimorbidity. Eight hypothesis-driven patterns were defined based on ""Low"" and ""High"" VAS levels. There were <0.2% days of Rhinitis Low and Asthma High or Conjunctivitis High patterns. There were 5.9% days with a Rhinitis HighAsthma Low pattern. There were 1.7% days with a Rhinitis HighAsthma HighConjunctivitis Lowpattern. A novel Rhinitis HighAsthma HighConjunctivitis High pattern was identified in 2.9% days and had the greatest impact on uncontrolled VAS global measured and impaired work productivity. Work productivity was significantly correlated with VAS global measured levels. ConclusionsIn a novel approach examining daily symptoms with mobile technology, we found considerable intra-individual variability of allergic multimorbidity including a previously unrecognized extreme pattern of uncontrolled multimorbidity.
  • article 34 Citação(ões) na Scopus
    Urbanization is associated with increased asthma morbidity and mortality in Brazil
    (2018) PONTE, Eduardo Vieira; CRUZ, Alvaro A.; ATHANAZIO, Rodrigo; CARVALHO-PINTO, Regina; FERNANDES, Frederico L. A.; BARRETO, Mauricio L.; STELMACH, Rafael
    IntroductionPrevious cross-sectional studies could establish an association between prevalence of self-reported wheeze and urban-rural environment, but the impact of urbanization on meaningful outcomes of asthma for public health is not established yet. ObjectivesEvaluate the effect of urbanization on asthma burden. MethodsA time series study of 5,505 Brazilian municipalities. The unit of analysis was the municipality. Two time frames were evaluated: from 1999 to 2001 and from 2009 to 2011. Trends from the first to the second time frame were evaluated. Governmental databases were the source of information. Multivariate binary logistic regression models were used. ResultsIn the age range from 5 to 24 years old, municipalities with increase in the proportion of individuals living in urban area had lower odds to reduce hospital admission rate from asthma (OR: .93) and lower odds to reduce death rate from asthma (OR: .88). In the age range from 25 to 39 years old, municipalities with increase in the proportion of individuals living in urban area had lower odds to reduce hospital admission rate from asthma (OR: .93) and lower odds to reduce death rate from asthma (OR: .82). Municipalities that increased access to physicians and that supplied inhaled corticosteroids free of charge for asthma since year 2003 had increased odds to reduce hospital admission and death rates from asthma. ConclusionsIncrease in urban population was associated with lower odds to reduce hospital admission and death rates from asthma in children and young adults living in a transition society.
  • article 16 Citação(ões) na Scopus
    Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels
    (2018) BOUSQUET, Jean; MOHAMMAD, Yousser; BEDBROOK, Anna; TO, Teresa; MCGIHON, Rachel; BARBARA, Cristina; MELO-GOMES, Elisabete; ROSADO-PINTO, Jose; SIMAO, Paula; GEORGE, Francisco; PUNTURIERI, Antonello; KILEY, James P.; NUNES, Elizabete; COSSA, Anilsa; CAMARGOS, Paulo; STELMACH, Raphael; CRUZ, Alvaro A.; ROSTAN, Marylin Valentin; YANEZ, Anahi; GONZALEZ-DIAZ, Sandra Nora; URRUTIA-PEREIRA, Marilyn; CALDERON, Moises A.; GOMEZ, Rene Maximiliano; GERMAN, Zachary; KOLEK, Vitezslav; SPICAK, Vaclav; Le Thi Tuyet Lan; HURD, Suzanne; LENFANT, Claude; YORGANCIOGLU, Arzu; GEMICIOGLU, Bilun; EKINCI, Banu; OZKAN, Zubeyda; AL-ZAHAB, Bassam Abou; DMEIRIEH, Ahmad; SHIFA, Rania; FAROUN, Hazar; ALJABER, Aicha; HALLOUM, Ramsa; FATMEH, Yassine; ALZEIN, Ammar; ALOUSH, Jamal; DIB, Ghazal; SHAABAN, Rafea; ARRAIS, Margarete; TEIXEIRA, Maria do Ceu; CONCEICAO, Claudia; FERRINHO, Paulo