FREDERICO LEON ARRABAL FERNANDES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor: CUKIER, Alberto ×

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Agora exibindo 1 - 10 de 25
  • article 47 Citação(ões) na Scopus
    Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?
    (2015) STELMACH, Rafael; FERNANDES, Frederico Leon Arrabal; CARVALHO-PINTO, Regina Maria; ATHANAZIO, Rodrigo Abensur; RACHED, Samia Zahi; PRADO, Gustavo Faibischew; CUKIER, Alberto
    Objective: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. Methods: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. Results: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. Conclusions: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.
  • conferenceObject
    Identification of functional phenotypes in people with COPD: influence of postural balance, physical activity, sedentary behaviour and quadriceps muscle strength
    (2019) XAVIER, Rafaella; CAPORALI, Ana Carolina; LOPES, Aline; OLIVEIRA, Cristino; FERNANDES, Frederico; STELMACH, Rafael; PINTO, Regina Carvalho; CUKIER, Alberto; CARVALHO, Celso
  • article 12 Citação(ões) na Scopus
    Recommendations for the pharmacological treatment of COPD: questions and answers
    (2017) FERNANDES, Frederico Leon Arrabal; CUKIER, Alberto; CAMELIER, Aquiles Assuncao; FRITSCHER, Carlos Cezar; COSTA, Claudia Henrique da; PEREIRA, Eanes Delgado Barros; GODOY, Irma; CANCADO, Jose Eduardo Delfini; ROMALDINI, Jose Gustavo; CHATKIN, Jose Miguel; JARDIM, Jose Roberto; RABAHI, Marcelo Fouad; NUCCI, Maria Cecilia Nieves Maiorano de; SALES, Maria da Penha Uchoa; CASTELLANO, Maria Vera Cruz de Oliveira; AIDE, Miguel Abidon; TEIXEIRA, Paulo Jose Zimermann; MACIEL, Renato; CORREA, Ricardo de Amorim; STIRBULOV, Roberto; ATHANAZIO, Rodrigo Abensur; RUSSO, Rodrigo; MINAMOTO, Suzana Tanni; LUNDGREN, Fernando Luiz Cavalcanti
    O tratamento da DPOC vem se tornando cada vez mais eficaz. Medidas que envolvem desde mudanças comportamentais, redução de exposições a fatores de risco, educação sobre a doença e seu curso, reabilitação, oxigenoterapia, manejo de comorbidades, tratamentos cirúrgicos e farmacológicos até os cuidados de fim de vida permitem ao profissional oferecer uma terapêutica personalizada e efetiva. O tratamento farmacológico da DPOC constitui um dos principais pilares desse manejo, e muitos avanços têm sido atingidos na área nos últimos anos. Com a maior disponibilidade de medicações e combinações terapêuticas fica cada vez mais desafiador conhecer as indicações, limitações, potenciais riscos e benefícios de cada tratamento. Com o intuito de avaliar criticamente a evidência recente e sistematizar as principais dúvidas referentes ao tratamento farmacológico da DPOC, foram reunidos 24 especialistas de todo o Brasil para elaborar a presente recomendação. Foi elaborado um guia visual para a classificação e tratamento adaptados à nossa realidade. Dez perguntas foram selecionadas pela relevância na prática clínica. Abordam a classificação, definições, tratamento e evidências disponíveis para cada medicação ou combinação. Cada pergunta foi respondida por dois especialistas e depois consolidadas em duas fases: revisão e consenso entre todos os participantes. As questões respondidas são dúvidas práticas e ajudam a selecionar qual o melhor tratamento, entre as muitas opções, para cada paciente com suas particularidades.
  • article 1 Citação(ões) na Scopus
    The patient profile of individuals with Alpha-1 antitrypsine gene mutations at a referral center in Brazil
    (2018) FELISBINO, Manuela Brisot; FERNANDES, Frederico Leon Arrabal; NUCCI, Maria Cecilia Nieves Maiorano de; PINTO, Regina Maria de Carvalho; PIZZICHINI, Emilio; CUKIER, Alberto
  • conferenceObject
    Incremental shuttle walking test: A reproducible and valid measure of exercise tolerance in adult subjects with non-cystic fibrosis bronchiectasis (nCF-BCt)
    (2013) CAMARGO, Anderson Alves de; RACHED, Samia Zahi; ATHANAZIO, Rodrigo Abensur; AMARAL, Tatiane Soares; LANZA, Fernanda de Cordoba; SELMAN, Jessyca Pachi Rodrigues; CUKIER, Alberto; FERNANDES, Frederico Leon Arrabal; CARVALHO, Celso Ricardo Fernandes; STELMACH, Rafael; CORSO, Simone Dal
  • conferenceObject
    Effect of weight-loss on the dynamic hyperinflation in obese asthmatics
    (2015) SILVA, Aline G.; FREITAS, Patricia D.; FERREIRA, Palmira G.; FERNANDES, Frederico L. A.; SALGE, Joao M.; STELMACH, Rafael; CUKIER, Alberto; MARTINS, Milton A.; CARVALHO, Celso R. F.
  • conferenceObject
    Airway resistance and obesity are independent factors for the occurrence of dynamic hyperinflation in asthmatics
    (2015) FERREIRA, Palmira G.; FREITAS, Patricia D.; SILVA, Aline G.; FERNANDES, Frederico L. A.; SALGE, Joao M.; STELMACH, Rafael; CUKIER, Alberto; CARVALHO-PINTO, Regina; MARTINS, Milton A.; CARVALHO, Celso R. F.
  • conferenceObject
    Dynamic hyperinflation and exercise limitation in obese asthmatics
    (2014) FERREIRA, Palmira G.; FREITAS, Patricia D.; SILVA, Aline G.; STELMACH, Rafael; CUKIER, Alberto; FERNANDES, Frederico L. A.; MARTINS, Milton A.; CARVALHO, Celso R. F.
  • article 6 Citação(ões) na Scopus
    Characterization of the severity of dyspnea in patients with bronchiectasis: correlation with clinical, functional, and tomographic aspects
    (2020) NUCCI, Maria Cecilia Nieves Maiorano de; FERNANDES, Frederico Leon Arrabal; SALGE, Joao Marcos; STELMACH, Rafael; CUKIER, Alberto; ATHANAZIO, Rodrigo
    Objective: To characterize a population of patients with bronchiectasis, correlating clinical, radiological, and functional aspects with the severity of dyspnea. Methods: This was a cross-sectional study involving adult patients with HRCT-confirmed bronchiectasis, categorized according to the severity of dyspnea (as being mildly or severely symptomatic, on the basis of the modified Medical Research Council scale). We correlated the severity of dyspnea with clinical parameters, functional parameters (spirometry values, lung volumes, and DLCO), and CT parameters. Results: We evaluated 114 patients, 47 (41%) of whom were men. The median age (interquartile range) was 42 years (30-55 years). The most common form was idiopathic bronchiectasis. Of the 114 patients, 20 (17.5%) were colonized with Pseudomonas aeruginosa and 59 (51.8%) were under continuous treatment with macrolides. When we applied the Exacerbation in the previous year, FEV1, Age, Colonization, Extension, and Dyspnea score, the severity of dyspnea was categorized as moderate in 54 patients (47.4%), whereas it was categorized as mild in 50 (43.9%) when we applied the Bronchiectasis Severity Index. The most common lung function pattern was one of obstruction, seen in 95 patients (83.3%), and air trapping was seen in 77 patients (68.7%). The prevalence of an obstructive pattern on spirometry was higher among the patients with dyspnea that was more severe, and most functional parameters showed reasonable accuracy in discriminating between levels of dyspnea severity. Conclusions: Patients with bronchiectasis and dyspnea that was more severe had greater functional impairment. The measurement of lung volumes complemented the spirometry data. Because bronchiectasis is a complex, heterogeneous condition, a single variable does not seem to be sufficient to provide an overall characterization of the clinical condition.
  • article 2 Citação(ões) na Scopus
    Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the Sao Paulo ""protocol""
    (2019) CARVALHO-PINTO, Regina Maria; SILVA, Ingredy Tavares da; NAVACCHIA, Lucas Yoshio Kido; GRANJA, Flavia Munhos; MARQUES, Gustavo Garcia; NERY, Telma de Cassia dos Santos; FERNANDES, Frederico Leon Arrabal; CUKIER, Alberto; STELMACH, Rafael
    Objective: A resolution passed by the government of the Brazilian state of Sao Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) Sao Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting beta(2) agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.