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
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- 2020 Brazilian Thoracic Association recommendations for the management of asthma(2020) PIZZICHINI, Marcia Margaret Menezes; CARVALHO-PINTO, Regina Maria de; CANCADO, Jose Eduardo Delfini; RUBIN, Adalberto Sperb; CERCI NETO, Alcindo; CARDOSO, Alexandre Pinto; CRUZ, Alvaro Augusto; FERNANDES, Ana Luisa Godoy; BLANCO, Daniella Cavalet; VIANNA, Elcio Oliveira; CORDEIRO JUNIOR, Gediel; RIZZO, Jose Angelo; FRITSCHER, Leandro Genehr; CAETANO, Lilian Serrasqueiro Ballini; PEREIRA, Luiz Fernando Ferreira; RABAHI, Marcelo Fouad; OLIVEIRA, Maria Alenita de; LIMA, Marina Andrade; ALMEIDA, Marina Buarque de; STELMACH, Rafael; PITREZ, Paulo Marcio; CUKIER, AlbertoThe pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
- Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study(2020) CUKIER, Alberto; GODOY, Irma de; COSTA, Claudia Henrique da; RUBIN, Adalberto Sperb; GREGORIO, Marcelo Gervilla; ALBUQUERQUE NETO, Aldo Agra de; LIMA, Marina Andrade; PEREIRA, Monica Corso; TANNI, Suzana Erico; ATHANAZIO, Rodrigo Abensur; BESSA, Elizabeth Jauhar Cardoso; WEHRMEISTER, Fernando Cesar; LOURENCO, Cristina Bassi; MENEZES, Ana Maria BaptistaObjective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV 1 (r = -0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.
conferenceObject Mycobacterium Parascrofulaceum in a Patient with Alpha 1 Antitrypsin Deficiency: Case Report(2020) BRIDI, G. D.; JESUS, R. M. De; SCHUBSKY, J.; LEIBEL, T.; ENDLICH, B. N.; RACHED, S. Z.; ATHANAZIO, R. A.; PINTO, R. M. De Carvalho; STELMACH, R.; CUKIER, A.- Identification of asthma phenotypes based on extrapulmonary treatable traits(2020) FREITAS, Patricia Duarte; XAVIER, Rafaella Fagundes; MCDONALD, Vanessa M.; GIBSON, Peter G.; CORDOVA-RIVERA, Laura; FURLANETTO, Karina C.; OLIVEIRA, Joice M. De; CARVALHO-PINTO, Regina M.; CUKIER, Alberto; STELMACH, Rafael; CARVALHO, Celso R. F.
- 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.
- 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
- The relationship between heart rate and VO2 in moderate-to-severe asthmatics(2020) MENDES, Felipe A. Rodrigues; TEIXEIRA, Renata Nakata; MARTINS, Milton A.; CUKIER, Alberto; STELMACH, Rafael; MEDEIROS, Wladimir Musetti; CARVALHO, Celso R. F.Objective: The main purpose of this study was to evaluate whether the %HRR-%VO2R relationship and %HRR-VO2peak relationship are affected in patients with moderate or severe asthma and whether airway obstruction and aerobic capacity influence these relationships. Methods: A linear regression was calculated using the paired %VO2R-%HRR and %VO2peak-%HRR for 93 subjects with asthma. The mean slope and y-intercept were calculated and compared with the line of identity (y-intercept = 0, slope = 1) for all patients and subgroups for the following conditions: low and normal VO2peak and low and normal FEV1. Results: The slope and intercepts of %VO2R-%HRR were similar to the line of identity for all groups (p > 0.05), and the regressions between %HRR and %VO2peak did not coincide with the line of identity for all groups (p < 0.05). There were no associations between the intercepts of the %HRR-VO2peak and the %HRR-%VO2R relationship with the VO2peak (p > 0.05) or FEV1 (p > 0.05). Conclusions: This is the first study to confirm a constant equivalence between %HRR and %VO2R in outpatients with moderate or severe asthma. Our data also suggest that the relationship between %HRR and %VO2peak is unreliable. These results support the use of %HRR in relation to %VO2R to estimate exercise intensity in this population, independently of the pulmonary function and fitness level.
- The effect of aerobic and breathing exercises on clinical control and psychosocial status in patients with moderate and severe asthma: a RCT(2020) KIM, Fabiana; ROCHA, Jaqueline; BOS, Denielli Da Silva Goncalves; BERTO, Cibele; LUNARDI, Adriana; WIRGUES, Andrey; FREITAS, Patricia Duarte; STELMACH, Rafael; CUKIER, Alberto; CARVALHO, Celso
- Effects of Aerobic Training Versus Breathing Exercises on Asthma Control: A Randomized Trial(2020) EVARISTO, Karen B.; MENDES, Felipe Augusto Rodrigues; SACCOMANI, Milene G.; CUKIER, Alberto; CARVALHO-PINTO, Regina M.; RODRIGUES, Marcos R.; SANTAELLA, Danilo F.; SARAIVA-ROMANHOLO, Beatriz M.; MARTINS, Milton A.; CARVALHO, Celso R. F.BACKGROUND: Aerobic training and breathing exercises are interventions that improve asthma control. However, the outcomes of these 2 interventions have not been compared. OBJECTIVE: To compare the effects of aerobic training versus breathing exercises on clinical control (primary outcome), quality of life, exercise capacity, and airway inflammation in outpatients with moderate-to-severe asthma. METHODS: Fifty-four asthmatics were randomized into either the aerobic training group (AG, n = 29) or the breathing exercise group (BG, n = 25). Both interventions lasted for 24 sessions (2/week, 40 minutes/session). Asthma clinical control (Asthma Control Questionnaire = ACQ]), quality of life (Asthma Quality of Life Questionnaire), asthma symptom-free days (ASFD), airway inflammation, exercise capacity, psychological distress (Hospital Anxiety and Depression Scale), daily-life physical activity (DLPA), and pulmonary function were evaluated before, immediately after, and 3 months after the intervention. RESULTS: Both interventions presented similar results regarding the ACQ score, psychological distress, ASFD, DLPA, and airway inflammation (P >.05). However, participants in the AG were 2.6 times more likely to experience clinical improvement at the 3-month follow-up than participants in the BG (P =.02). A greater proportion of participants in the AG also presented a reduction in the number of days without rescue medication use compared with BG (34% vs 8%; P = .04). CONCLUSIONS: Outpatients with moderate-to-severe asthma who participated in aerobic training or breathing exercise programs presented similar results in asthma control, quality of life, asthma symptoms, psychological distress, physical activity, and airway inflammation. However, a greater proportion of participants in the AG presented improvement in asthma control and reduced use of rescue medication. (C) 2020 American Academy of Allergy, Asthma & Immunology
- Automated computed tomography lung densitometry in bronchiectasis patients(2020) SAWAMURA, Marcio Yamada; ATHANAZIO, Rodrigo Abensur; NUCCI, Maria Cecilia Nieves Teixeira Maiorano De; RACHED, Samia Zahi; CUKIER, Alberto; CAVALHO-PINTO, Regina Maria; STELMACH, Rafael; ASSUNCAO JUNIOR, Antonildes Nascimento; TAKAHASHI, Marcelo Straus; NOMURA, Cesar Higa