ALBERTO CUKIER
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
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conferenceObject Elastic fibers and fibronectin expression in severe asthmatics(2013) FERREIRA, Diogenes; ANNONI, Raquel; CARVALHO-PINTO, Regina Maria; RABE, Klaus; CUKIER, Alberto; STELMACH, Rafael; DOLHNIKOFF, Marisa; MAUAD, Thais- Small airway evolution of a Brazilian severe asthmatic cohort (BRASASP): 10 years follow up(2020) SANTOS JUNIOR, Nilton Goncalves Dos; LIMA, Renato Miranda; ATHANAZIO, Rodrigo Abensur; PINTO, Regina Maria De Carvalho; SALGE, Joao Marcos; RABE, Klaus; CUKIER, Alberto; STELMACH, Rafael
conferenceObject Correlation between airway smooth muscle (ASM) and eosinophilic inflammation in severe non-controlled asthmatics(2012) CARVALHO-PINTO, Regina Maria; CUKIER, Alberto; MAUAD, Thais; DOLHNIKOFF, Marisa; GREGORIO, Marcelo Gervilla; PIRES NETO, Ruy Camargo; TELES, Aila Mirtes; RABE, Klaus F.; STELMACH, Rafael- Clinical characteristics and possible phenotypes of an adult severe asthma population(2012) CARVALHO-PINTO, Regina Maria de; CUKIER, Alberto; ANGELINI, Luciene; ANTONANGELO, Leila; MAUAD, Thais; DOLHNIKOFF, Marisa; RABE, Klaus F.; STELMACH, RafaelBackground: Currently, there are no studies of well-characterized severe asthmatics in Brazil. We aimed to study a population of severe treated asthmatics still uncontrolled to characterize them and define possible phenotypes. Methods: Descriptive cross-sectional outpatient study of severe asthmatics, evaluating functional and inflammatory markers, health-related quality of life, anxiety and depression symptoms, clinical control status, and characteristics related to atopy, age of asthma onset, induced sputum eosinophil levels, and airflow limitation. We also grouped the subgroups characteristics to identify phenotypes. The study is registered on ClinicalTrial.gov NCT 01089322. Results: From 128 eligible patients with severe/uncontrolled asthma, 74 fulfilled the inclusion criteria. The cohort was comprised of 85% women, frequently with a body mass index higher than 31 kg m(-2), atopy (60%), early-onset disease (50%), sputum eosinophilia (80%), comorbidities, and reduced quality of life. Nonatopics had significant higher asthma onset (19 y.a.) and twice level of induced sputum eosinophil. Late-onset patients had significantly less atopy (57%) and higher levels of induced sputum eosinophils. Non-eosinophilics had lower levels of inflammatory markers. Patients with airflow limitation had more intensive care unit admissions (56%) and 1.5 times more airway resistance. Subgroups characteristics identified a priori four well-characterized phenotypes, with 55% presenting sputum eosinophilia. Conclusion: Our data emphasize the high burden of disease, the persistence of inflammation and the existence of clinical possible phenotypes population sharing common features with published cohorts. Despite the necessity of further investigation into pathogenic mechanisms, this study with clinically difficult patient group may help to improve future asthma care.
conferenceObject Collagens And Airway Function In Severe Asthma(2013) FERREIRA, D. S.; PINTO, R. M. C.; OLIVEIRA, B. L.; FRARI, H. S. Del; RABE, K. F.; CUKIER, A.; STELMACH, R.; DOLHNIKOFF, M.; MAUAD, T.- 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.
conferenceObject Quantitative Airway Wall Thickness In Severe Asthmatic Patients: An Useful Prognostic Tool But Not Predictor To Therapy(2014) ATHANAZIO, R. A.; CARVALHO-PINTO, R.; JASINOWODOLINSKI, D.; RACHED, S. Z.; MAIORANO, M. C.; FERNANDES, F. L. A.; RABE, K.; CUKIER, A.; STELMACH, R.- Airway pathology in severe asthma is related to airflow obstruction but not symptom control(2018) FERREIRA, D. S.; CARVALHO-PINTO, R. M.; GREGORIO, M. G.; ANNONI, R.; TELES, A. M.; BUTTIGNOL, M.; ARAUJO-PAULINO, B. B.; KATAYAMA, E. H.; OLIVEIRA, B. L.; FRARI, H. S. Del; CUKIER, A.; DOLHNIKOFF, M.; STELMACH, R.; RABE, K. F.; MAUAD, T.BackgroundPatients with asthma present structural and inflammatory alterations that are believed to play a role in disease severity. However, airway remodeling and inflammation have not been extensively investigated in relation to both symptom control and airflow obstruction in severe asthmatics. We aimed to investigate several inflammatory and structural pathological features in bronchial biopsies of severe asthmatics that could be related to symptom control and airflow obstruction after standardized treatment. MethodsFifty severe asthmatics received prednisone 40 mg/d for 2 weeks and maintenance therapy with budesonide/formoterol 400/12 g twice daily + budesonide/formoterol 200/6 g as needed for 12 weeks. Endobronchial biopsies were performed at the end of 12 weeks. We performed extensive immunopathological analyses of airway tissue inflammation and remodeling features in patients stratified by asthma symptom control and by airflow obstruction. ResultsAirway tissue inflammation and remodeling were not associated with symptom control. Asthmatics with persistent airflow obstruction had greater airway smooth muscle (Asm) area with decreased periostin and transforming growth factor beta-positive cells within Asm bundles, in addition to lower numbers of chymase-positive mast cells in the submucosa compared to patients with nonpersistent obstruction. ConclusionsSymptom control in severe asthmatics was not associated with airway tissue inflammation and remodeling, although persistent airflow obstruction in these patients was associated with bronchial inflammation and airway structural changes.
conferenceObject AIRWAY REMODELING DIFFERENTIATES ALLERGIC FROM NONALLERGIC SEVERE ASTHMA(2014) FERREIRA, Diogenes S.; ANNONI, Raquel; CARVALHO-PINTO, Regina M.; KATAYAMA, Edgard H.; FRARI, Heloisa S. Del; OLIVEIRA, Bianca L.; RABE, Klaus F.; CUKIER, Alberto; STELMACH, Rafael; DOLHNIKOFF, Marisa; MAUAD, ThaisconferenceObject Mucoid Impaction Can Predict Oral Corticosteroids Response In Severe Asthmatic Patients(2014) ATHANAZIO, R. A.; CARVALHO-PINTO, R.; JASINOWODOLINSKI, D.; FERNANDES, F. L. A.; MAIORANO, M. C.; RACHED, S. Z.; RABE, K. F.; CUKIER, A.; STELMACH, R.