FREDERICO LEON ARRABAL FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
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
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
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- 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, AlbertoObjective: 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.
- 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 CavalcantiO 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.
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 DalconferenceObject 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.- 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, RodrigoObjective: 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.
- 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, RafaelIntroductionPrevious 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.
bookPart Cor pulmonale(2016) FERNANDES, Frederico Leon Arrabal; ATHANAZIO, Rodrigo Abensur; STELMACH, Rafael; CUKIER, AlbertoconferenceObject Prevalence Of Dinamic Hyperinflation And Aerobic Capacity Assessment In Bronchiectasis Patients(2017) NUCCI, M. N. Maiorano De; FERNANDES, F. L. A.; ATHANAZIO, R. A.; SALGE, J. M.; STELMACH, R.; CUKIER, A.conferenceObject Clinical, functional and microbiological characteristics of an adult br Tian cystic fibrosis population(2014) RACHED, Samia Zahi; ATHANAZIO, Rodrigo; MAIORANO, Maria Cecilia Nieves Teixeira; FERNANDES, Frederico; CARVALHO-PINTO, Regina; CUKIER, Alberto; STELMACH, Rafael- Can severe asthmatic patients achieve asthma control? A systematic approach in patients with difficult to control asthma followed in a specialized clinic(2016) ATHANAZIO, Rodrigo; CARVALHO-PINTO, Regina; FERNANDES, Frederico Leon Arrabal; RACHED, Samia; RABE, Klaus; CUKIER, Alberto; STELMACH, RafaelBackground: Despite advances in asthma treatment, severe asthma (SA) still results in high morbidity and use of health resources. Our hypothesis was that SA patients would achieve adequate control with a systematic protocol, including oral corticosteroids, budesonide/formoterol maintenance and reliever therapy and a multidisciplinary approach to improve adherence. Methods: Non-controlled (NC) SA patients were enrolled to receive 2 weeks of oral corticosteroids and 12 weeks of formoterol + budesonide. Assessments included asthma control questionnaire (ACQ), asthma control test (ACT), daily symptom diary, lung function and health-related quality of life (HRQoL) questionnaires. Results: Of 51 patients, 13 (25.5%) achieved control. NC patients had higher utilization of health resources and higher exacerbation rates. Both controlled (C) and NC patients had significantly reduced ACQ scores after oral corticosteroid treatment. After 12 weeks, C patients continued improving. NC patients did not have significant changes. A similar pattern was found regarding lung function, use of rescue medication, and days free of symptoms. After 2 weeks of oral corticosteroids, an increase occurred in those who achieved the ACQ cut off; however, 53.8% of C patients had an ACQ < 1.57 versus 21.1% of NC patients (p = 0.03). Both groups had low HRQoL at baseline with improvement after intervention. Conclusions: Despite rigorous, optimized follow-up treatment, 75% of SA patients did not achieve adequate symptom control and presented with impaired quality of life. Conversely, application of a low-cost, easy to implement systematic protocol can prevent up to 25% of SA patients from up-titrating to new and complex therapies, thus reducing costs and morbidity.