Artigo Original / Original Article
A importância do estudo da difusão alvéolo-capilar, como complemento da pletismografia, na avaliação funcional de fumadores
The importance of diffusing capacity as a complementary study to plethysmography in smokers
1 Pneumologista e Professor auxiliar convidado da Cadeira de Fisiologia Humana – Universidade do Porto – ICBAS (Instituto de Ciências Biomédicas de Abel Salazar). Consultor de fisiopatologia respiratória do Hospital Geral de Santo António / Pulmonologist and guest professor, Human Physiology – Porto University – ICBAS (Instituto de Ciências Biomédicas de Abel Salazar). Consultant in Respiratory Physiopathology, Santo António Hospital
2 Pneumologista e chefe de Serviço de Pneumologia do Hospital da Força Aérea, responsável pelo Laboratório de Função Pulmonar. Director Clínico da Clínica de Doentes Pulmonares, Lisboa / Pulmonologist and head of the Pulmonology unit of the Portuguese Air Force Hospital. Head of the Pulmonary Function Laboratory. Clinical Director of the Pulmonary Clinic, Lisbon
3 Chefe de Serviço do Serviço de Cuidados Intensivos do Hospital Geral de Santo António. Assistente Convidado de Clínica Médica II (Pneumologia). Responsável pelo laboratório de Função Pulmonar do Hospital Geral de Santo António/ Head of the ICU at Santo António Hospital. Guest professor, Medical Clinic II (Pulmonology). Head of the Pulmonary Function Laboratory, Santo António Hospital
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Consultor de fisiopatologia respiratória do Hospital Geral de Santo António / <span class="elsevierStyleItalic">Pulmonologist and guest professor, Human Physiology – Porto University – ICBAS (Instituto de Ciências Biomédicas de Abel Salazar). Consultant in Respiratory Physiopathology, Santo António Hospital</span>" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Pneumologista e chefe de Serviço de Pneumologia do Hospital da Força Aérea, responsável pelo Laboratório de Função Pulmonar. Director Clínico da Clínica de Doentes Pulmonares, Lisboa / <span class="elsevierStyleItalic">Pulmonologist and head of the Pulmonology unit of the Portuguese Air Force Hospital. Head of the Pulmonary Function Laboratory. Clinical Director of the Pulmonary Clinic, Lisbon</span>" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Chefe de Serviço do Serviço de Cuidados Intensivos do Hospital Geral de Santo António. Assistente Convidado de Clínica Médica II (Pneumologia). Responsável pelo laboratório de Função Pulmonar do Hospital Geral de Santo António/ <span class="elsevierStyleItalic">Head of the ICU at Santo António Hospital. Guest professor, Medical Clinic II (Pulmonology). Head of the Pulmonary Function Laboratory, Santo António Hospital</span>" "etiqueta" => "3" "identificador" => "af0015" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The importance of diffusing capacity as a complementary study to plethysmography in smokers" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-06-27" "fechaAceptado" => "2007-09-12" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570423" "palabras" => array:4 [ 0 => "Transferência alvéolo-capilar" 1 => "<span class="elsevierStyleItalic">single breath</span>" 2 => "pletismografia" 3 => "fumadores" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570424" "palabras" => array:4 [ 0 => "Alveolar-capillary transfer" 1 => "single breath" 2 => "plethysmography" 3 => "smokers" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Foram estudados 194 casos de fumadores e exfumadores (≥ 1 UMA), de ambos os sexos e idades compreendidas entre os 20 e os 82 anos, tendo sido excluídos doentes detentores de patologias ou antecedentes profissionais de risco. Apresentavam grau variado de sintomatologia e exame pletismográfico normal, mas com valores anormais do factor de transferência alvéolo-capilar, determinados pelo método de <span class="elsevierStyleItalic">single breath</span> com CO (TL<span class="elsevierStyleInf">CO</span> SB e TL<span class="elsevierStyleInf">CO</span> /VA). Dos 194 casos avaliados, 136 (70,1%) tinham valores anormais de um ou dos dois parâmetros referidos. No tratamento estatístico da amostra (teste do qui-quadrado), a diferença da sensibilidade entre ambos os parâmetros foi significativa (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0001). As eventuais limitações do método de avaliação usado (<span class="elsevierStyleItalic">single breath</span>) foram, no presente estudo, minimizadas (restrição ventilatória com capacidade vital<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1,5 litros), pela normalidade referida do exame pletismográfico. De igual modo, a presença de alterações da distribuição ventilatória foi, em princípio, excluída pela ausência de valores da relação CPT-sb/CPTplet inferiores a 0,85.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusões:</span> A normalidade do exame pletismográfico em grandes fumadores ou ex-fumadores não é suficiente para afirmar uma normalidade da função respiratória, visto que grande percentagem de casos apresenta anormalidades do factor de transferência alvéolo-capilar pelo CO. A limitação alveolar considerada foi, não só a anatómica, mas, igualmente, a de carácter funcional.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIII (6): 763-774</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">This study comprised 194 male and female heavy smokers or ex-smokers (≥ 1 pack-year) aged between 20 and 82, whose symptoms varied. Cases were only selected from patients with normal whole-body plethysmography. Subjects with any significant pathology and occupational risk factors were excluded from the study.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Varying degrees of symptoms were found and a range of results from normal plethysmography examination, with abnormal levels of alveolar-capillary transfer, determined by the single-breath method to analyse CO (TL<span class="elsevierStyleInf">CO</span> and TL<span class="elsevierStyleInf">CO</span> -VA) coefficients. Using the chi-square test for statistical analysis of the sample revealed a significant variation in sensitivity between both parameters (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001).</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Possible limitations of using the single-breath method, of were reduced in this study (ventilatory restriction withVital Capacity <<span class="elsevierStyleHsp" style=""></span>1.5 litres) by the routine plethysmography results seen. Likewise, the presence of alterations in ventilatory distribution was, in principle, minimised by the absence of TLCsb/TLCplet values below 0.85%</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions</span>: Normal plethysmography results in heavy or ex-smokers are not enough to confirm normal respiratory function, as a large percentage of cases present abnormalities in the alveolar-capillary transfer factor for CO. Alveolar limitation was considered not only anatomically, but also from a functional perspective.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIII (6): 763-774</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia / Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation inhomogeneity in α1-antitrypsin-deficient emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Fregonese" 1 => "H.P.A.A. Van Veen" 2 => "P.J. Sterk" 3 => "J. 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Article information
ISSN: 08732159Original language: Portuguese
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