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
24 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 24
- 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.
- Efeito agudo do salbutamol no sistema cardiovascular durante o exercício físico em pacientes com asma moderada ou grave: estudo aleatorizado, duplo-cego e cruzado(2018) MELO, Jaqueline Ribas de; FEITOZA, Maiane da Silva; CUCATO, Gabriel Grizzo; MEDEIROS, Wladimir Musetti; STELMACH, Rafael; CUKIER, Alberto; CARVALHO, Celso Ricardo Fernandes de; MENDES, Felipe Augusto RodriguesABSTRACT Salbutamol is a β2-agonist of short duration commonly used in patients with asthma to prevent symptoms during or after exercise. Hemodynamic changes at rest are well described. However, there is little data on the effects on heart rate (HR) and blood pressure (BP) during exercise and recovery phase in patients with moderate or severe asthma A randomized, double-blind, cross-over study was conducted, including 15 individuals with moderate and severe asthma, mean age 46.4±9.3 years. Patients underwent a maximal 2-day exercise test with 400 mcg salbutamol or 4 placebo puffs. Throughout the protocol, HR, BP, perceived exertion and peak of expiratory flow (PEF) were monitored. After the use of salbutamol, the PEF value increased by a mean of 28.0±47.7L/m, remaining increased at 5, 10 and 15 minutes of passive recovery compared to placebo (p<0.05). The HR, BP and effort perception variables were similar across interventions at all stages of the protocol (p>0.05). These results suggest that the use of salbutamol is safe and that HR does not need to be adjusted to prescribe exercise intensity following salbutamol administration in subjects with moderate or severe asthma.
- 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.
- Effects of a behaviour change intervention aimed at increasing physical activity on clinical control of adults with asthma: study protocol for a randomised controlled trial(2019) FREITAS, Patricia D.; XAVIER, Rafaella F.; PASSOS, Natalia F. P.; CARVALHO-PINTO, Regina M.; CUKIER, Alberto; MARTINS, Milton A.; CAVALHERI, Vinicius; HILL, Kylie; STELMACH, Rafael; CARVALHO, Celso R. F.Background: In adults with asthma, physical activity has been associated with several asthma outcomes. However, it is unclear whether changes in physical activity, measured via an accelerometer, have an effect on asthma control. The objective of the present study is, in adults with moderate-to-severe asthma, to investigate the effects of a behaviour change intervention, which aims to increase participation in physical activity, on asthma clinical control. Methods: This is a single-blind (outcome assessor), two-arm, randomised controlled trial (RCT). Fifty-five participants with moderate-to-severe asthma, receiving optimized pharmacological treatment, will be randomly assigned (computer-generated) into either a Control Group (CG) or an Intervention Group (IG). Both groups will receive usual care (pharmacological treatment) and similar educational programmes. In addition to these, participants in the IG will undergo the behaviour change intervention based on feedback, which aims to increase participation in physical activity. This intervention will be delivered over eight sessions as weekly one-on-one, face-to-face 40-min consultations. Both before and following the completion of the intervention period, data will be collected on asthma clinical control, levels of physical activity, health-related quality of life, asthma exacerbation and levels of anxiety and depression symptoms. Anthropometric measurements will also be collected. Information on comorbidities, lung function and the use of asthma medications will be extracted from the participant's medical records. Discussion: If successful, this study will demonstrate that, in adults with asthma, a behavioural change intervention which aims to increase participation in physical activity also affects asthma control.
- 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.
- Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care?(2017) JOSE, Anderson; HOLLAND, Anne E.; OLIVEIRA, Cristiane S. de; SELMAN, Jessyca P. R.; CASTRO, Rejane A. S. de; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone DalBackground: Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis.& para;& para;Objectives: To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis.& para;& para;Methods: An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. Interventions: The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20 min (intensity: 60-80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). Control: The patients will receive an educational manual and a recommendation to walk three times a week for 30 min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. Main outcome measures: incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization.& para;& para;Discussion: The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis.
- Vocal cord dysfunction diagnosis may be improved by a screening check list(2016) PINTO, Lucia Helena Eduardo; AUN, Marcelo Vivolo; CUKIER-BLAJ, Sabrina; STELMACH, Rafael; CUKIER, Alberto; KALIL, Jorge; AGONDI, Rosana Camara; GIAVINA-BIANCHI, PedroBackground: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. Methods: A prospective observational study involving 80 patients aged >= 8 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer ""yes"" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. Results: The proportion of affirmative answers to the question ""Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?"" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable ""4 or more affirmative answers"" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
- 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.
- Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial(2021) JOSE, Anderson; HOLLAND, Anne E.; SELMAN, Jessyca P. R.; CAMARGO, Cristiane Oliveira de; FONSECA, Diogo Simoes; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone DalAim: To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. Methods: Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. Results: After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4-143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. Conclusion: HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.
- 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
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