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
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- High-intensity interval training (HIIT) versus constant-load exercise (CLE) on the short-acute beta agonist (SABA) consumption and peak-expiratory flow (PEF) in subjects with moderate to severe asthma(2023) SILVA, Ronaldo Aparecido Da; FERNANDES, Thiago; STELMACH, Rafael; CUKIER, Alberto; CARVALHO-PINTO, Regina Maria; CARVALHO, Celso R. F.
- Postural balance assessment in fallers individuals with COPD before and after physical effort(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De
- A study of the psychometric properties of the Brazilian-Portuguese version of Bronchiectasis Health Questionnaire(2023) LUPPO, A.; CAMARGO, C. O. de; BIRRING, S. S.; LUNARDI, A. C.; RACHED, S. Z.; ATHANAZIO, R. A.; STELMACH, R.; CORSO, S. D.Introduction and objective: The Bronchiectasis Health Questionnaire (BHQ) is a simple, repeatable, and self-reporting health status questionnaire for bronchiectasis. This study aims to cross-culturally adapt the BHQ into Brazilian Portuguese and evaluate its measurement properties.Methods: The participants answered the Saint George's Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) scale for dyspnea. The Brazilian-Portuguese version of the Bronchiectasis Health Questionnaire (BHQ-Brazil) was used at baseline (test) and after 14 days (retest). The psychometric analyses included internal consistency, test-retest reliability, and construct validity: factorial validity, convergent validity, and discriminative validity, agreement, and ceiling and floor effects. Results: The BHQ-Brazil demonstrated adequate internal consistency (Cronbach's alpha = 0.92) and substantial reliability (intraclass correlation coefficient = 0.86; 95%CI: 0.79--0.90). The exploratory factorial analysis was considered suitable. All items presented a factorial load >0.40. The convergent validity of the BHQ-Brazil with mMRC was moderate (r = -0.53, p < 0.001), while concurrent validity with the SGRQ was strong (symptoms: r = -0.72, activities: r = -0.60, impact: r = -0.60, total score: r = -0.75, all p < 0.001). The standard error of measurement was 4.81 points. The discriminative validity demonstrated that individuals with more pulmonary exacerbations, colonization by Pseudomonas aeruginosa, worst dyspnea, and a higher number of affected lung lobes presented the lowest quality of life. No floor or ceiling effects were observed.Conclusion: The BHQ-Brazil presents adequate measurement properties to evaluate the impact of bronchiectasis on health-related quality of life, and can be used in clinical and research settings.(c) 2020 Sociedade Portuguesa de Pneumologia.
- Identifying the Characteristics of Responders and Nonresponders in a Behavioral Intervention to Increase Physical Activity Among Patients With Moderate to Severe Asthma: Protocol for a Prospective Pragmatic Study(2023) LIMA, Fabiano Francisco de; LUNARDI, Adriana Claudia; PINHEIRO, David Halen Araujo; CARVALHO-PINTO, Regina Maria; STELMACH, Rafael; GIAVINA-BIANCHI, Pedro; AGONDI, Rosana Camara; CARVALHO, Celso R. F.Background: Previous research has suggested that most adults improve their asthma control after a short-term behavioral intervention program to increase physical activity in daily life (PADL). However, the characteristics of individuals who respond and do not respond to this intervention and the medium-term response remain unknown.Objective: This study aims to (1) identify the characteristics of adult responders and nonresponders with asthma to a behavioral intervention to increase physical activity and (2) evaluate the functional and clinical benefits in the medium term.Methods: This prospective pragmatic study will include adults with moderate to severe asthma who enroll in a behavioral intervention. All individuals will receive an educational program and an 8-week intervention to increase PADL (1 time/wk; up to 90 min/session). The educational program will be conducted in a class setting through group discussions and video presentations. Behavioral interventions will be based on the transtheoretical model using counseling, incentives, and individual feedback aiming to increase participation in physical activity. Motivational interviewing and guidelines for overcoming barriers will be used to stimulate individuals to reach their goals. Pre-and postintervention assessments will include the following: PADL (triaxial accelerometry), body composition (octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and exacerbations. ""Responders"" to the intervention will be defined as those who demonstrate an increase in the number of daily steps (& GE;2500). Results: In December 2021, the clinical trial registration was approved. Recruitment and data collection for the trial is ongoing, and the results of this study are likely to be published in late 2024. Conclusions: The intervention will likely promote different effects according to the clinical characteristics of the individuals, including asthma control, age, anxiety and depression levels, obesity, and several comorbidities. Identifying individuals who respond or do not respond to behavioral interventions to increase PADL will help clinicians prescribe specific interventions to adults with asthma.Trial Registration: ClinicalTrials.gov NCT05159076; https://clinicaltrials.gov/ct2/show/NCT05159076International Registered Report Identifier (IRRID): DERR1-10.2196/49032
- Work-related asthma consequences on socioeconomic, asthma control, quality of life, and psychological status compared with non-work-related asthma: A cross-sectional study in an upper-middle-income country(2023) ROIO, Lavinia Clara; STELMACH, Rafael; MIZUTANI, Rafael F. F.; TERRA-FILHO, Mario; SANTOS, Ubiratan d. P.BackgroundWork-related asthma (WRA) is the most prevalent occupational respiratory disease, and it has negative effects on socioeconomic standing, asthma control, quality of life, and mental health status. Most of the studies on WRA consequences are from high-income countries; there is a lack of information on these effects in Latin America and in middle-income countries. MethodsThis study compared socioeconomic, asthma control, quality of life, and psychological outcomes among individuals diagnosed with WRA and non-work-related asthma (NWRA) in a middle-income country. Patients with asthma, related and not related to work, were interviewed using a structured questionnaire to assess their occupational history and socioeconomic conditions, and with questionnaires to assess asthma control (Asthma Control Test and Asthma Control Questionnaire-6), quality of life (Juniper's Asthma Quality of Life Questionnaire), and presence of anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Each patient's medical record was reviewed for exams and use of medication, and comparisons were made between individuals with WRA and NWRA. ResultsThe study included 132 patients with WRA and 130 with NWRA. Individuals with WRA had worse socioeconomic outcomes, worse asthma control, more quality-of-life impairment, and a higher prevalence of anxiety and depression than individuals with NWRA. Among individuals with WRA, those who had been removed from occupational exposure had a worse socioeconomic impact. ConclusionsConsequences on socioeconomic, asthma control, quality of life, and psychological status are worse for WRA individuals when compared with NWRA.
- The imbalance between subpopulations of regulatory T (TREG) Cells at different stages of chronic obstructive pulmonary disease (COPD)(2023) ALVES, Luan Henrique Vasconcelos; A, Juliana Tiyaki Ito; OLIVEIRA, Luana Mendonca De; TIBERIO, Iolanda Lopes Calvo; STELMACH, Rafael; SATO, Maria Notomi; ALMEIDA, Francine Maria; LOPES, Fernanda Degobbi Tenorio Quirino dos Santos
conferenceObject Exercise Capacity as a Predictor of 3-year Mortality in Adult Bronchiectasis Patients(2023) RACHED, S. Z.; CAMARGO, A. A. de; ATHANAZIO, R. A.; CORSO, S. dal; STELMACH, R.bookPart Terapia inalatória(2023) LIMA, Renato Miranda; CARVALHO-PINTO, Regina Maria de; STELMACH, Rafael- Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis(2023) BOUSQUET, J.; MELEN, E.; HAAHTELA, T.; KOPPELMAN, G. H.; TOGIAS, A.; VALENTA, R.; AKDIS, C. A.; CZARLEWSKI, W.; ROTHENBERG, M.; VALIULIS, A.; WICKMAN, M.; CHIVATO, T.; AGUILAR, D.; CHKHARTISHVILI, E.; CHRISTOFF, G.; CHU, D. K.; CINGI, C.; SOUSA, J. Correia de; CORRIGAN, C.; CUSTOVIC, A.; OGULUR, I.; GUERRA, S.; D'AMATO, G.; GIACCO, S. Del; BLAY, F. De; BEDBROOK, A.; DEVILLIER, P.; DIDIER, A.; TEIXEIRA, M. do Ceu; DOKIC, D.; DOUAGUI, H.; DOULAPTSI, M.; HEINRICH, J.; BURTE, E.; DURHAM, S.; DYKEWICZ, M.; EIWEGGER, T.; EL-SAYED, Z. A.; BINDSLEV-JENSEN, C.; EMUZYTE, R.; FIOCCHI, A.; FYHRQUIST, N.; GOMEZ, R. M.; IVANCEVICH, J. C.; GOTUA, M.; BLAIN, H.; GUZMAN, M. A.; HAGEMANN, J.; HAMAMAH, S.; HALKEN, S.; HALPIN, D. M. G.; BOSNIC-ANTICEVICH, S.; HOFMANN, M.; HOSSNY, E.; KEIL, T.; HRUBISKO, M.; IRANI, C.; OHTA, K.; ISPAYEVA, Z.; JARES, E.; JARTTI, T.; JASSEM, E.; JULGE, K.; JUST, J.; BOULET, L. P.; KLIMEK, L.; JUTEL, M.; KAIDASHEV, I.; KALAYCI, O.; OKUBO, K.; KALYONCU, A. F.; KARDAS, P.; KIRENGA, B.; KRAXNER, H.; KULL, I.; KULUS, M.; KUNA, P.; GRUTTA, S. La; BRIGHTLING, C. E.; LAU, S.; THI, L. Le Tuyet; OUEDRAOGO, S.; LEVIN, M.; LIPWORTH, B.; LOURENCO, O.; MAHBOUB, B.; MARTINEZ-INFANTE, E.; KUPCZYK, M.; MATRICARDI, P.; MICULINIC, N.; MIGUERES, N.; BRUSSINO, L.; MIHALTAN, F.; OLZE, H.; PALI-SCHOELL, I.; PALOMARES, O.; PALOSUO, K.; PANAITESCU, C.; KVEDARIENE, V.; PANZNER, P.; PARK, H. S.; BONINI, M.; BUSTAMANTE, M.; PITSIOS, C.; PLAVEC, D.; POPOV, T. A.; PUGGIONI, F.; QUIRCE, S.; RECTO, M.; LARENAS-LINNEMANN, D. E.; REPKA-RAMIREZ, M. S.; CORDEIRO, C. Robalo; ROCHE, N.; BRAIDO, F.; RODRIGUEZ-GONZALEZ, M.; CANONICA, G. W.; ROMANTOWSKI, J.; ROSARIO FILHO, N.; ROTTEM, M.; SAGARA, H.; CAMARGOS, P.; SERPA, F. S.; SAYAH, Z.; SCHEIRE, S.; SCHMID-GRENDELMEIER, P.; BUHL, R.; SISUL, J. C.; SOLE, D.; CECCHI, L.; SOTO-MARTINEZ, M.; SOVA, M.; MOHAMMAD, Y.; SPERL, A.; SPRANGER, O.; STELMACH, R.; ULRIK, C. Suppli; THOMAS, M.; BUMBACEA, R. S.; TO, T.; TODO-BOM, A.; TOMAZIC, P. V.; CELEDON, J. C.; LEMONNIER, N.; URRUTIA-PEREIRA, M.; VALENTIN-ROSTAN, M.; GANSE, E. Van; HAGE, M. van; VASANKARI, T.; VICHYANOND, P.; BUSH, A.; VIEGI, G.; WALLACE, D.; WANG, D. Y.; CARLSEN, K. C. Lodrup; WILLIAMS, S.; LOUREIRO, C. Chaves; WORM, M.; YIALLOUROS, P.; YUSUF, O.; ZAITOUN, F.; ZERNOTTI, M.; CALDERON, M.; ZIDARN, M.; ZUBERBIER, J.; LOUIS, R.; FONSECA, J. A.; ZUBERBIER, T.; ANTO, J. M.; COSTA, E.; CRUZ, A. A.; ERHOLA, M.; GEMICIOGLU, B.; FOKKENS, W. J.; CALVO-GIL, M.; GARCIA-AYMERICH, J.; MAKELA, M.; MAKRIS, M.; MAURER, M.; MOMAS, I.; MORAIS-ALMEIDA, M.; MULLOL, J.; NACLERIO, R. N.; MONIUSZKO, M.; CARABALLO, L.; NADEAU, K.; NADIF, R.; NIEDOSZYTKO, M.; OKAMOTO, Y.; OLLERT, M.; PAPADOPOULOS, N. G.; PASSALACQUA, G.; PATELLA, V.; PAWANKAR, R.; MONTEFORT, S.; PHAM-THI, N.; AKDIS, M.; PFAAR, O.; REGATEIRO, F. S.; RING, J.; ROUADI, P. W.; SAMOLINSKI, B.; SASTRE, J.; SAVOURE, M.; SCICHILONE, N.; NEFFEN, H.; SHAMJI, M. H.; SHEIKH, A.; CARDONA, V.; SIROUX, V.; SOUSA-PINTO, B.; STANDL, M.; SUNYER, J.; TABORDA-BARATA, L.; TOPPILA-SALMI, S.; TORRES, M. J.; NEKAM, K.; TSILIGIANNI, I.; VALOVIRTA, E.; VANDENPLAS, O.; CARR, W.; VENTURA, M. T.; WEISS, S.; YORGANCIOGLU, A.; ZHANG, L.; LATIFF, A. H. Abdul; ABERER, W.; NUNES, E.; AGACHE, I.; AL-AHMAD, M.; ALOBID, I.; ANSOTEGUI, I. J.; CARREIRO-MARTINS, P.; ARSHAD, S. H.; ASAYAG, E.; BARBARA, C.; BAHARUDIN, A.; BATTUR, L.; TSHIPUKANE, D. Nyembue; BENNOOR, K. S.; BERGHEA, E. C.; BERGMANN, K. C.; BERNSTEIN, D.; BEWICK, M.; CASALE, T.; SARABIA, A. M. Cepeda; CHANDRASEKHARAN, R.; CHARPIN, D.; CHEN, Y. Z.; O'HEHIR, R.; CHERREZ-OJEDA, I.Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of ""one-airway-one-disease,"" coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the ""Epithelial Barrier Hypothesis."" This review determined that the ""one-airway-one-disease"" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme ""allergic"" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.
- Obstructive sleep apnea and falls in COPD patients: a cross-sectional and follow-up study(2023) CENSO, Caroline Maschio de; PASSINI, Viviane Vieira; VERRI, Barbara Aparecida Teodoro Alcantara; PINTO, Regina Maria De Carvalho; STELMACH, Rafael; XAVIER, Rafaella Fagundes; LORENZI-FILHO, Geraldo; CARVALHO, Celso Ricardo Fernandes De