Browsing by Author "Cardoso, João"
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- Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) studyPublication . Müller, A.; Wouters, E. F.; Koul, P.; Welte, T.; Harrabi, I.; Rashid, A.; Loh, L. C.; Al Ghobain, M.; Elsony, A.; Ahmed, R.; Potts, J.; Mortimer, K.; Rodrigues, F.; Paraguas, S. N.; Juvekar, S.; Agarwal, D.; Obaseki, D.; Gislason, T.; Seemungal, T.; Nafees, A. A.; Jenkins, C.; Dias, Hermínia Brites; Franssen, F. M.; Studnicka, M.; Janson, C.; Cherkaski, H. H.; El Biaze, M.; Mahesh, P. A.; Cardoso, João; Burney, P.; Hartl, S.; Janssen, D. J.; Amaral, A. F.Background: Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. This study aimed to estimate the prevalence of dyspnoea across several world regions and to investigate the association of dyspnoea with lung function. Methods: Dyspnoea was assessed, and lung function was measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. Results: The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC
- Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal studyPublication . Knox-Brown, Ben; Algharbi, Fahad; Mulhern, Octavia; Potts, James; Harrabi, Imed; Janson, Christer; Nielsen, Rune; Agarwal, Dhiraj; Malinovschi, Andrei; Juvekar, Sanjay; Denguezli, Miriam; Gíslason, Thorarinn; Ahmed, Rana; Nafees, Asaad; Koul, Parvaiz A.; Obaseki, Daniel; Anand, Mahesh Padukudru; Loh, Li Cher; Hermínia Brites Dias; Rodrigues, Fátima; Mannino, David; Elbiaze, Mohammed; El Rhazi, Karima; Mejza, Filip; Devereux, Graham; Franssen, Frits; El Sony, Asma; Wouters, Emiel; Al Ghobain, Mohammed; Mortimer, Kevin; Rashid, Abdul; Osman, Rashid; Studnicka, Michael; Cardoso, João; Burney, Peter; Amaral, André; BOLD Collaborative Research GroupBackground: Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time. Methods: The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003, and December 26, 2016. Follow-up measurements were collected between January 29, 2019, and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status, and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers. Findings: We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had a 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than in men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20). Interpretation: Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.
- COPD: should diagnosis match physiology?Publication . Studnicka, Michael; Horner, Andreas; Sator, Lea; Buist, A. Sonia; Lamprecht, Bernd; Zhong, NanShan; Liu, Shengming; Lu, Jiachun; Ran, Pixin; Wang, Dali; Zheng, Jingping; Koopman, Mariana; Louw, Innocentia; Ludick, Ina; Olckers, Alta; Ryck, Johanna; Storbeck, Janita; Gislason, Thorarinn; Benedikdtsdottir, Bryndis; Jörundsdottir, Kristin; Gudmundsdottir, Lovisa; Ferreira, Reis; Gudmundsdottir, Sigrun; Gundmundsson, Gunnar; Nizankowska-Mogilnicka, Ewa; Frey, Jakub; Harat, Rafal; Mejza, Filip; Nastalek, Pawel; Pajak, Andrzej; Skucha, Wojciech; Szczeklik, Andrzej; Janson, Christer; Twardowska, Magda; Welte, Tobias; Bodemann, Isabelle; Geldmacher, Henning; Schweda-Linow, Alexandra; Gulsvik, Amund; Endresen, Tina; Svendsen, Lene; Tan, Wan C.; Wang, Wen; Olafsdottir, Inga Sif; Mannino, David M.; Cain, John; Copeland, Rebecca; Hazen, Dana; Methvin, Jennifer; Dantes, Renato B.; Amarillo, Lourdes; Berratio, Lakan U.; Fernandez, Lenora C.; Francisco, Norberto A.; Nisser, Katarina; Garcia, Gerard S.; de Guia, Teresita S.; Idolor, Luisito F.; Naval, Sullian S.; Reyes, Thessa; Roa, Camilo C.; Sanchez, Ma. Flordeliza; Simpao, Leander P.; Jenkins, Christine; Marks, Guy; Spetz-Nyström, Ulrike; Bird, Tessa; Espinel, Paola; Hardaker, Kate; Toelle, Brett; Burney, Peter G.J.; Amor, Caron; Potts, James; Tumilty, Michael; McLean, Fiona; Wouters, E.F.M.; Hägg, Gunilla; Wesseling, G.J.; Bárbara, Cristina; Rodrigues, Fátima; Dias, Hermínia Brites; Cardoso, João; Almeida, João; Matos, Maria João; Simão, Paula; Santos, Moutinho; Lund, Gun-Marie; Jõgi, Rain; Laja, Hendrik; Ulst, Katrin; Zhou, Yumin; Zobel, Vappu; Lill, Toomas-Julius; Koul, Parvaiz A.; Malik, Sajjad; Hakim, Nissar A.; Khan, Umar Hafiz; Chowgule, Rohini; Shetye, Vasant; Raphael, Jonelle; Almeda, Rosel; Kocabaş, Ali; Tawde, Mahesh; Tadvi, Rafiq; Katkar, Sunil; Kadam, Milind; Dhanawade, Rupesh; Ghurup, Umesh; Harrabi, Imed; Denguezli, Myriam; Tabka, Zouhair; Daldoul, Hager; Hancioglu, Attila; Boukheroufa, Zaki; Chouikha, Firas; Khalifa, Wahbi Belhaj; Idolor, Luisito F.; de Guia, Teresita S.; Francisco, Norberto A.; Roa, Camilo C.; Ayuyao, Fernando G.; Tady, Cecil Z.; Tan, Daniel T.; Hanta, Ismail; Banal-Yang, Sylvia; Balanag, Vincent M.; Reyes, Maria Teresita N.; Dantes, Renato. B.; Juvekar, Sanjay; Hirve, Siddhi; Sambhudas, Somnath; Chaidhary, Bharat; Tambe, Meera; Pingale, Savita; Kuleci, Sedat; Umap, Arati; Umap, Archana; Shelar, Nitin; Devchakke, Sampada; Chaudhary, Sharda; Bondre, Suvarna; Walke, Savita; Gawhane, Ashleshsa; Sapkal, Anil; Argade, Rupali; Turkyilmaz, Ahmet Sinan; Gaikwad, Vijay; Salvi, Sundeep; Brashier, Bill; Londhe, Jyoti; Madas, Sapna; Obaseki, Daniel; Erhabor, Gregory; Awopeju, Olayemi; Adewole, Olufemi; Umut, Sema; Unalan, Turgay; Studnicka, Michael; Dawes, Torkil; Lamprecht, Bernd; Sator, Lea; Bateman, Eric; Jithoo, Anamika; Adams, Desiree; Barnes, Edward; Freeman, Jasper; Hayes, Anton; Hlengwa, Sipho; Johannisen, ChristineWe are very grateful to Dr. Vanfleteren and colleagues for commenting on our data regarding overdiagnosed COPD2 and for putting this evidence into the framework of the current understanding of the disease. Based on the data presented on overdiagnosis, and on prior Burden of Obstructive Lung Disease (BOLD) observations on underdiagnosis,3 we truly believe that our worldwide community of pulmonary specialists could do much better in caring for this extremely prevalent and devastating disease. Overall, our data indicate that for one patient with a “matched” COPD diagnosis (ie, the presence of postbronchodilator airway obstruction and a positive recall of such a diagnosis), there is always another “mismatched,” false-positive patient with COPD. This patient possibly experiences all the untoward consequences, such as receiving expensive and possibly harmful medication, and missing chances for treatment of cardiac disease or asthma. On the contrary, for each “known” patient with COPD who has a poorly reversible airway obstruction, there are four to five other patients out there with yet undetected airways obstruction. Again, we are missing opportunities in these patients for smoking intervention, symptom relief, and prolongation of their lives.
- Estudo da eficiência de deteção de um monitor portátil de contaminação de superfícies em função da distância e do débito de emissão da fontePublication . Duarte, Diana D.; Cardoso, João; Santos, Luís; Oliveira, Carlos; Vieira, LinaIntrodução – No caso de uma eventual contaminação radioativa esta deve ser quantificada, pelo que é necessário garantir que as condições de funcionamento de um monitor de contaminação de superfícies se encontrem adequadamente caracterizadas, através da determinação da sua eficiência de deteção. Este estudo tem como objetivo determinar a eficiência de deteção de um monitor de contaminação e analisar a influência da distância e da atividade. Metodologia – O monitor de contaminação Thermo Mini 900E e as fontes radioativas planas de referência de Carbono – 14 (C-14), Césio – 137 (Cs-137), Estrôncio – 90 (Sr-90), Cloro – 36 (Cl-36) e Amerício – 241 (Am-241) com débito de emissão superficial rastreável ao Physikalish Technischen Bundesanstalt (PTB) foram utilizadas. Fontes de Sr-90 e C-14 com dois débitos de emissão distintos para cada e distâncias de 1 a 20mm foram usados para estudar a sua influência na eficiência de deteção. Resultados – Verificou-se que as fontes radioativas emissoras de partículas de maior energia apresentam uma maior eficiência de deteção e que esta diminui com o aumento da distância do detetor à fonte, sendo que os radioisótopos de maior energia apresentam um decréscimo na eficiência de 15% ao longo de 20mm, enquanto os radioisótopos de menor energia apresentam um decréscimo de 10%. Não se verificou uma influência expressiva do débito de emissão na eficiência de deteção deste monitor de contaminação. Conclusão – A eficiência de deteção de um monitor de contaminação portátil é dependente da distância deste à contaminação bem como do tipo de radiação emitida e energia dos radioisótopos presentes na contaminação. - ABSTRACT - Introduction – A radioactive contamination needs to be quantified in case it eventually occurs. Therefore it is necessary to ensure that the operating conditions of a surface contamination monitor are characterized by determining its detection efficiency. This experimental study aims to determine the detection efficiency of a contamination monitor and evaluate the distance and surface emission rate influence on the detection efficiency. Methodology – A contamination monitor Thermo Mini 900E was tested with reference radiation sources of Carbon – 14 (C-14), Cesium – 137 (Cs-137), Strontium – 90 (Sr-90), Chlorine – 36 (Cl-36) and Americium – 241 (Am-241) with its emission rate traced to the Physikalish Technischen Bundesanstalt (PTB). Sources of Sr-90 and C-14 with two different emission rates for each one and distances of 1 to 20mm were used to study its influence in the detection efficiency. Results – With the increasing of distance, the detection efficiency decreases. The most energetic radiation sources have higher detection efficiency, boasting a 15% decrease over 20mm whereas the sources bearing a smaller efficiency decrease 10%. No influence of the surface emission rate in the detection efficiency was verified. Conclusion – Thus, it is concluded that the detection efficiency of a contamination monitor is dependent of the distance between it and the contamination as well as the type and energy of the radioisotopes present in the contamination.
- Estudo da resposta de um dosímetro eletrónico individualPublication . Duarte, Diana D.; Cardoso, João; Santos, Luís; Oliveira, Carlos; Vieira, LinaIntrodução – A monitorização da exposição ocupacional a doses de radiação ionizante pode ser complementada por dosímetros eletrónicos individuais que permitem uma leitura direta da dose de radiação recebida. Dada a dependência energética e de débito de dose já reportada para estes dosímetros, este trabalho pretende determinar a linearidade da resposta de um dosímetro eletrónico individual e estudar o comportamento da sua resposta em função da energia de radiação e do débito de dose. Metodologia – Para estudar a dependência da energia da radiação do dosímetro eletrónico pessoal Vertec Bleeper Sv procedeu‑se à sua irradiação com um equivalente de dose individual, Hp(10), de 500 μSv de radiação gama do Cobalto – 60 (60C) e Césio – 137 (137Cs) e das qualidades de radiação X da série Narrow (N): N‑30, N‑40, N‑60, N‑80, N‑100 e N‑120. Para investigar a dependência da resposta em função do débito de dose aplicaram‑se à ampola de raios X as intensidades de corrente elétrica de 1 mA, 5 mA, 10 mA, 15 mA e 20 mA. Resultados – Não existe uma relação entre a resposta do detetor e a energia de radiação a que este é exposto. Ocorre uma subestimação superior a 50% na grandeza medida para energias inferiores a 33 keV, mas ostenta uma medida relativamente linear da grandeza Hp(10) para doses inferiores a 100 μSv. Também se constata que, à medida que o débito de dose aumenta, existe uma diminuição na resposta do dosímetro. O menor decréscimo na resposta deste dosímetro eletrónico individual dá‑se para as qualidades de radiação N‑30 (1,1%), N‑40 (4,1%) e N‑120 (20,0%). Conclusão – Verifica‑se que a resposta do dosímetro individual Vertec Bleeper Sv depende fortemente da energia da radiação e do débito de dose. ABSTRACT: Introduction – The measurement of occupational exposure to radiation doses can be completed with an electronic personal dosemeter that allows a direct reading and alarm function of the received radiation dose. Due to the energy and dose rate dependence already reported for this type of dosemeter, it is intended, with this work, to determine the response linearity of an Electronic Personal Dosemeter and to study its response behavior to the dose rate and radiation energy. Methodology – The electronic personal dosemeter Vertec Bleeper Sv energy dependency was evaluated by its irradiation with 500 μSv from the radionuclides Cobalt – 60 (60C) and Cesium – 137 (137Cs) as well as by the radiation qualities of the Narrow (N) series: N‑30, N‑40, N‑60, N‑80, N‑100 e N‑120. To investigate the dose rate dependency, the intensities of electric current of 1 mA, 5 mA, 10 mA, 15 mA and 20 mA were applied to the X‑ray tube. Results – There is no relationship between the response of the detector and the radiation energy. For energies below 33 keV there is an underestimation over 50% of the radiation dose measured but the detector presents a linear response for energies under 100 μSv. A dependency on the dose rate is perceived since as the dose rate increases, the response of the individual monitor decreases. There is a smaller decrease for the radiation qualities of N‑30 (1.1%), N‑40 (4.1%) and N‑120 (20.0%). Conclusion – It is concluded that there is a strong dependence of radiation energy and dose rate on the response of an electronic personal dosemeter.
- Overdiagnosis of COPD in subjects with unobstructed spirometryPublication . Sator, Lea; Horner, Andreas; Studnicka, Michael; Lamprecht, Bernd; Kaiser, Bernhard; McBurnie, Mary Ann; Buist, A. Sonia; Gnatiuc, Luisa; Mannino, David M.; Janson, Christer; Bateman, Eric D.; Burney, Peter; Zhong, NanShan; Liu, Shengming; Lu, Jiachun; Ran, Pixin; Wang, Dali; Zheng, Jingping; Zhou, Yumin; Kocabaş, Ali; Hancioglu, Attila; Hanta, Ismail; Kuleci, Sedat; Turkyilmaz, Ahmet Sinan; Umut, Sema; Unalan, Turgay; Studnicka, Michael; Dawes, Torkil; Lamprecht, Bernd; Sator, Lea; Bateman, Eric; Jithoo, Anamika; Adams, Desiree; Barnes, Edward; Freeman, Jasper; Hayes, Anton; Hlengwa, Sipho; Johannisen, Christine; Koopman, Mariana; Louw, Innocentia; Ludick, Ina; Olckers, Alta; Ryck, Johanna; Storbeck, Janita; Gislason, Thorarinn; Benedikdtsdottir, Bryndis; Jörundsdottir, Kristin; Gudmundsdottir, Lovisa; Gudmundsdottir, Sigrun; Gundmundsson, Gunnar; Nizankowska-Mogilnicka, Ewa; Frey, Jakub; Harat, Rafal; Mejza, Filip; Nastalek, Pawel; Pajak, Andrzej; Skucha, Wojciech; Szczeklik, Andrzej; Twardowska, Magda; Welte, Tobias; Bodemann, Isabelle; Geldmacher, Henning; Schweda-Linow, Alexandra; Gulsvik, Amund; Endresen, Tina; Svendsen, Lene; Tan, Wan C.; Wang, Wen; Mannino, David M.; Cain, John; Copeland, Rebecca; Hazen, Dana; Methvin, Jennifer; Dantes, Renato B.; Amarillo, Lourdes; Berratio, Lakan U.; Fernandez, Lenora C.; Francisco, Norberto A.; Garcia, Gerard S.; de Guia, Teresita S.; Idolor, Luisito F.; Naval, Sullian S.; Reyes, Thessa; Roa, Camilo C.; Sanchez, Ma. Flordeliza; Simpao, Leander P.; Jenkins, Christine; Marks, Guy; Bird, Tessa; Espinel, Paola; Hardaker, Kate; Toelle, Brett; Burney, Peter G.J.; Amor, Caron; Potts, James; Tumilty, Michael; McLean, Fiona; Wouters, E.F.M.; Wesseling, G.J.; Bárbara, Cristina; Rodrigues, Fátima; Dias, Hermínia Brites; Cardoso, João; Almeida, João; Matos, Maria João; Simão, Paula; Santos, Moutinho; Ferreira, Reis; Janson, Christer; Olafsdottir, Inga Sif; Nisser, Katarina; Spetz-Nyström, Ulrike; Hägg, Gunilla; Lund, Gun-Marie; Jõgi, Rain; Laja, Hendrik; Ulst, Katrin; Zobel, Vappu; Lill, Toomas-Julius; Koul, Parvaiz A.; Malik, Sajjad; Hakim, Nissar A.; Khan, Umar Hafiz; Chowgule, Rohini; Shetye, Vasant; Raphael, Jonelle; Almeda, Rosel; Tawde, Mahesh; Tadvi, Rafiq; Katkar, Sunil; Kadam, Milind; Dhanawade, Rupesh; Ghurup, Umesh; Harrabi, Imed; Denguezli, Myriam; Tabka, Zouhair; Daldoul, Hager; Boukheroufa, Zaki; Chouikha, Firas; Khalifa, Wahbi Belhaj; Idolor, Luisito F.; de Guia, Teresita S.; Francisco, Norberto A.; Roa, Camilo C.; Ayuyao, Fernando G.; Tady, Cecil Z.; Tan, Daniel T.; Banal-Yang, Sylvia; Balanag, Vincent M.; Reyes, Maria Teresita N.; Dantes, Renato B.; Juvekar, Sanjay; Hirve, Siddhi; Sambhudas, Somnath; Chaidhary, Bharat; Tambe, Meera; Pingale, Savita; Umap, Arati; Umap, Archana; Shelar, Nitin; Devchakke, Sampada; Chaudhary, Sharda; Bondre, Suvarna; Walke, Savita; Gawhane, Ashleshsa; Sapkal, Anil; Argade, Rupali; Gaikwad, Vijay; Salvi, Sundeep; Brashier, Bill; Londhe, Jyoti; Madas, Sapna; Obaseki, Daniel; Erhabor, Gregory; Awopeju, Olayemi; Adewole, OlufemiBackground: There are several reports on the underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false-positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods: A false-positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). Results: Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false-positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false-positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false-positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions: False-positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.
- Prevalência de obstrução numa população exposta ao fumo do tabaco – Projecto PNEUMOBILPublication . Ferreira, J.M.; Matos, Maria João; Rodrigues, Fátima; Belo, Aurora; Dias, Hermínia Brites; Cardoso, João; Simão, Paula; Moutinho dos Santos, J.; Almeida, João; Gouveia, António; Bárbara, CristinaA espirometria não atingiu ainda a divulgação que se justificaria em patologia respiratória, ou indivíduos que se encontram em risco relativamente a esta patologia, cujo diagnóstico é insuficiente, havendo um escasso conhecimento, e consequente controlo, dos custos atribuíveis a estas doenças, com destaque para a doença pulmonar obstrutiva crónica (DPOC). O PNEUMOBIL, iniciativa que visa esta divulgação entre fumadores e ex-fumadores, foi reactivado, após 10 anos de aplicação em Portugal, revelando agora, numa amostra de 5324 indivíduos, em que cerca de 50% ainda mantêm os hábitos tabágicos, sejam do sexo masculino ou feminino, que houve uma elevada prevalência de obstrução detectada por espirometria (30% e 25%, respectivamente) nas pessoas rastreadas perto de centros de saúde (grupo público) e em empresas (grupo privado). Este risco não se explica em regra por exposição ocupacional, nem se relaciona com a maioria dos sintomas respiratórios, muito frequentes nos rastreados. Apenas a dispneia (OR = 1,28; p = 0,02) e os episódios frequentes de expectoração (OR = 1,21; p = 0,008) ou de bronquite aguda (OR = 1,31; p = 0,05) revelam alguma relação com a obstrução. O reconhecimento prévio da DPOC é muito reduzi-do e a presença de obstrução não se correlaciona (p = 0,204) com o assumir da condição de portador.