RAFAEL STELMACH
Projetos de Pesquisa
Unidades Organizacionais
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
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- In-person and online application of the Bronchiectasis Health Questionnaire: are they interchangeable?(2022) LUPPO, Adriano; RACHED, Samia Z.; ATHANAZIO, Rodrigo A.; STELMACH, Rafael; CORSO, Simone Dal
- Automated Computed Tomography Lung Densitometry in Bronchiectasis Patients(2022) SAWAMURA, Marcio Valente Yamada; ATHANAZIO, Rodrigo Abensur; NUCCI, Maria Cecilia Nieves Teixeira Maiorano de; RACHED, Samia Zahi; CUKIER, Alberto; STELMACH, Rafael; ASSUNCAO- JR., Antonildes Nascimento; TAKAHASHI, Marcelo Straus; NOMURA, Cesar Higa
- Accuracy and economic evaluation of screening tests for undiagnosed COPD among hypertensive individuals in Brazil(2022) MARTINS, S. M.; DICKENS, A. P.; SALIBE-FILHO, W.; ALBUQUERQUE NETO, A. A.; ADAB, P.; ENOCSON, A.; COOPER, B. G.; SOUSA, L. V. A.; SITCH, A. J.; JOWETT, S.; ADAMS, R.; CHENG, K. K.; CHI, C.; CORREIA-DE-SOUSA, J.; FARLEY, A.; GALE, N.; JOLLY, K.; MAGLAKELIDZE, M.; MAGHLAKELIDZE, T.; STAVRIKJ, K.; TURNER, A. M.; WILLIAMS, S.; JORDAN, R. E.; STELMACH, R.In Brazil, prevalence of diagnosed COPD among adults aged 40 years and over is 16% although over 70% of cases remain undiagnosed. Hypertension is common and well-recorded in primary care, and frequently co-exists with COPD because of common causes such as tobacco smoking, therefore we conducted a cross-sectional screening test accuracy study in nine Basic Health Units in Brazil, among hypertensive patients aged >= 40 years to identify the optimum screening test/combinations to detect undiagnosed COPD. We compared six index tests (four screening questionnaires, microspirometer and peak flow) against the reference test defined as those below the lower limit of normal (LLN-GLI) on quality diagnostic spirometry, with confirmed COPD at clinical review. Of 1162 participants, 6.8% (n = 79) had clinically confirmed COPD. Peak flow had a higher specificity but lower sensitivity than microspirometry (sensitivity 44.3% [95% CI 33.1, 55.9], specificity 95.5% [95% CI 94.1, 96.6]). SBQ performed well compared to the other questionnaires (sensitivity 75.9% [95% CI 65.0, 84.9], specificity 59.2% [95% CI 56.2, 62.1]). A strategy requiring both SBQ and peak flow to be positive yielded sensitivity of 39.2% (95% CI 28.4, 50.9) and specificity of 97.0% (95% CI 95.7, 97.9). The use of simple screening tests was feasible within the Brazilian primary care setting. The combination of SBQ and peak flow appeared most efficient, when considering performance of the test, cost and ease of use (costing & POUND;1690 (5554 R$) with 26.7 cases detected per 1,000 patients). However, the choice of screening tests depends on the clinical setting and availability of resources.
- Postural balance in COPD with obstructive sleep apnea: a cross-sectional study(2022) CENSO, C. Maschio de; PASSINI, V. Vieira; VERRI, B. Aparecida Teodoro Alcantara; CARVALHO-PINTO, R. Maria De; STELMACH, R.; LORENZI-FILHO, G.; XAVIER, R. Fagundes; CARVALHO, C. Ricardo Fernandes
- Constant-Load Exercise Versus High-Intensity Interval Training on Aerobic Fitness in Moderate-to-Severe Asthma: A Randomized Controlled Trial(2022) SILVA, Ronaldo Aparecido da; STELMACH, Rafael; OLIVEIRA, Luanda Mara da Silva; SATO, Maria Notomi; CUKIER, Alberto; CARVALHO, Celso Ricardo FernandesBACKGROUND: The effects of high-intensity interval training (HIIT) on dyspnea and aerobic fitness in adults with asthma are poorly understood. OBJECTIVE: To compare constant-load exercise (CLE) versus HIIT for improvements in dyspnea symptoms and clinical control in adults with moderate-to-severe asthma. METHODS: Participants were randomized into 2 groups: CLE (n = 27; started with 70% of maximal watts [Wmax] obtained during cardiopulmonary exercise testing [CPET]) and HIIT (n = 28; started with 80% and increased until 140% Wmax). Exercise training lasted 12 weeks (twice/week, 40 minutes/ session on a cycle ergometer), and the intensity was based on CPET. Clinical asthma control (Asthma Control Questionnaire), aerobic fitness (the peak of oxygen uptake), health-related quality of life (Asthma Quality of Life Questionnaire), physical activity levels (PAL; accelerometer), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), and dyspnea were evaluated before and after the intervention. Systemic and airway inflammation were also assessed. Two-way analysis of variance and chi(2) tests were used for comparisons. Sixteen participants dropped out during the interventions and returned for the final evaluations. RESULTS: The CLE and HIIT groups showed similar improvements in aerobic fitness. The HIIT group had lower dyspnea and fatigue perception scores and higher PAL than the CLE group (P < .05) and clinical improvements in the psychosocial distress. In addition, only the HIIT group achieved a minimal clinically important difference in asthma symptoms. There was no change in the systemic and airway inflammation (P > .05). CONCLUSION: Both interventions promoted similar improvements in aerobic fitness; however, HIIT induced a greater reduction in dyspnea and fatigue perception. Similar responses were observed for other variables. (C) 2022 American Academy of Allergy, Asthma & Immunology
- Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single-site, randomised controlled trial from the Breathe Well Group(2022) MAGLAKELIDZE, Mariam; KURUA, Ia; MAGLAKELIDZE, Nino; MAGLAKELIDZE, Tamaz; CHKHAIDZE, Ivane; GOGVADZE, Ketevan; CHKHAIDZE, Natia; BEADLE, Helen; REDDEN-ROWLEY, Kelly; ADAB, Peymane; ADAMS, Rachel; CHI, Chunhua; CHENG, K. K.; COOPER, Brendan; CORREIA-DE-SOUSA, Jaime; DICKENS, Andrew P.; ENOCSON, Alexandra; FARLEY, Amanda; GALE, Nicola K.; JOWETT, Sue; MARTINS, Sonia; RAI, Kiran; SITCH, Alice J.; STAVRIKJ, Katarina; STELMACH, Rafael; TURNER, Alice M.; WILLIAMS, Sian; JORDAN, Rachel E.; JOLLY, KateObjectives To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT). Design A two-arm, randomised feasibility trial with a mixed-methods process evaluation. Setting Secondary care setting in Georgia, Europe. Participants People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care. Interventions Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting. Primary and secondary outcome measures Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews. Results The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of <= 50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George's Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was -24.9 (95% CI -40.3 to -9.6) at programme end and -4.4 (95% CI -12.3 to 3.4) at 6 months follow-up for the intervention group and -0.5 (95% CI -8.1 to 7.0) and -8.1 (95% CI -16.5 to 0.3) for the usual care group at programme end and 6 months, respectively. Conclusions It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research.
- Community lung health service design for COPD patients in China by the Breathe Well group(2022) PANG, Hui; PAN, Zihan; ADAMS, Rachel; DUNCAN, Eleanor; CHI, Chunhua; KONG, Xia; ADAB, Peymane; CHENG, Kar Keung; COOPER, Brendan G.; CORREIA-DE-SOUSA, Jaime; DICKENS, Andrew P.; ENOCSON, Alexandra; FARLEY, Amanda; GALE, Nicola; JOLLY, Kate; JOWETT, Sue; MAGLAKELIDZE, Mariam; MAGHLAKELIDZE, Tamaz; MARTINS, Sonia; SITCH, Alice; STAVRIK, Katarina; STELMACH, Raphael; TURNER, Alice; WILLIAMS, Sian; JORDAN, Rachel E.COPD is increasingly common in China but is poorly understood by patients, medications are not used as prescribed and there is no access to recommended non-pharmacological treatment. We explored COPD patients' and general practitioners' (GPs) knowledge of COPD, views on its management and the acceptability of a flexible lung health service (LHS) offering health education, exercise, self-management, smoking cessation and mental health support. Using a convergent mixed methods design, data were collected from patients and GPs using focus groups (FGs) in four Chinese cities, questionnaires were also used to collect data from patients. FGs were audio-recorded and transcribed. Quantitative data were analysed descriptively, thematic framework analysis was used for the qualitative data. Two-hundred fifty-one patients completed the questionnaire; 39 patients and 30 GPs participated in ten separate FGs. Three overarching themes were identified: patients' lack of knowledge/understanding of COPD, current management of COPD not meeting patients' needs and LHS design, which was well received by patients and GPs. Participants wanted COPD education, TaiChi, psychological support and WeChat for social support. 39% of survey responders did not know what to do when their breathing worsened and 24% did not know how to use their inhalers. 36% of survey respondents requested guided relaxation. Overall, participants did not fully understand the implications of COPD and current treatment was sub-optimal. There was support for developing a culturally appropriate intervention meeting Chinese patients' needs, health beliefs, and local healthcare delivery. Further research should explore the feasibility of such a service.
- Effect of physical effort on postural balance in COPD and OSA(2022) CENSO, C. Maschio de; PASSINI, V. Vieira; VERRI, B. Aparecida Teodoro Alcantara; CARVALHO-PINTO, R. Maria De; STELMACH, R.; LORENZI-FILHO, G.; XAVIER, R. Fagundes; CARVALHO, C. Ricardo Fernandes
- Prevalence of the eosinophilic phenotype among severe asthma patients in Brazil: the BRAEOS study(2022) ATHANAZIO, Rodrigo; STELMACH, Rafael; ANTILA, Martti; SOUZA-MACHADO, Adelmir; ARRUDA, L. Karla; NETO, Alcindo Cerci; SERPA, Faradiba Sarquis; BLANCO, Daniela Cavalet; LIMA, Marina; BIANCHI JUNIOR, Pedro; PENHA, Marcio; RABAHI, Marcelo FouadObjective: To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. Methods: This was a cross- sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. Results: A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm(3) and 231 had a blood eosinophil count of <= 300 cells/mm(3). The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m(2) and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.144.9), and that of those with a blood eosinophil count > 300 cells/ mm(3) and a history of allergy was 31.9% ( 95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm(3) (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm(3) (OR = 1.02, p = 0.0011). Conclusions: This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.